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Priority Settings for CHA (because we can’t always do what we want…). Gianfranco Pezzino Senior Fellow and Strategy Team Leader Kansas Health Institute. Prioritization.
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Priority Settings for CHA(because we can’t always do what we want…) Gianfranco Pezzino Senior Fellow and Strategy Team Leader Kansas Health Institute
Prioritization A process whereby an individual or group places a number of items in rank order based on their perceived or measured importance or significance Source: APEXPH in practice
Exercise • Look at the list of health issues on the next slide • Take no more than 1 minute to rank on a piece of paper the health issues (most important first) • Be ready to present and justify your ranking
Obesity Alzheimer disease IMR Cancer Vaccine-preventable disease Unintentional injuries Cardio-vascular disease Foodborne disease Mental illness HIV infection Oral health
Report • What are “your” priorities? • How did you come to this conclusion? • Could there be something missing?
Do we have a consensus? • If not, what would it take to get to a consensus?
Key Issues • “…an individual or group places a number of items …” • Each of us has values through which we judge the world • For group prioritization, we need to “combine” values from multiple people • “…based on their perceived or measured importance…” • Some issues have significance beyond statistics
Priority Settings Tools • Many tools available: • “Qualitative”: build consensus, based primarily on perceptions and values (e.g., brainstorming, affinity diagrams, Pareto charts, etc.) • “Quantitative”: use data (e.g., statistics, scores, indexes, evidence of effectiveness) • Mixing tools is often recommended
Resources (all provided) • Handbook, page 6 • Memory Jogger • NACCHO: “Tip Sheet” • Additional resources available upon request
Model for Ranking Process • Decide and refine criteria to use for ranking • Decide relative significance of each criterion (weights) • Define list of potential issues • Use a ranking method of choice, identify 2-6 priority issues • Develop an improvement plan / action plan to address the priority issues
Model for Ranking Process • Decide and refine criteria to use for ranking
How to Reach Consensus on Criteria • Involve the stakeholders in the process • Can start from a provided list of criteria or leave options open • This is a very important step: • If there is no agreement on how to judge each health issue, there can be no real consensus • Vision and mission statements may be helpful
Commonly Used Criteria • MAGNITUDE: How many people are affected? • SERIOUSNESS: How severe is the issue? • STRATEGIES: Is the problem responsive to interventions • FEASIBILITY: How feasible is an intervention to attack this problem? • CONCERN: What is the level of concern in the community?
Model for Ranking Process • Decide and refine criteria to use for ranking • Define list of potential issues
Why Compiling a List of Potential Issues? • People need to know WHAT to rank and prioritize • Start from your data profile: • If relatively few measures, that can be your list • If lots of measures, you need to develop shorter list • Several techniques can be helpful (e.g., nominal group, “dotmocracy”)
Hands-on Activity (5 minutes) • Refer to the handout with KHM priority indicators • Imagine that you have included in your CHA the 20 KHM priority health indicators • Spend a few minutes thinking which 10 indicators should be ranked for priority setting • Put a colored sticker next to the 10 selected indicators on the flip chart (in no particular order) • The 10 indicators with more stickers will be then prioritized
Discussion • What do you think of this method?
Model for Ranking Process • Decide and refine criteria to use for ranking • Define list of potential issues • Use a ranking method of choice, identify 2-6 priority issues
Recap • Now you have: • A list of issues to rank • Criteria for ranking them • Useful techniques: • Nominal Group • Dotmocracy • Multi-voting technique • Others (see handout from North Carolina)
Are We Done Yet…? • Review the results of the ranking process • Does the group members recognize themselves in that list? • Can everyone live with that? • Make adjustments as necessary • Process is only a tool • Process serves the team, not vice versa • Adapt process based on the group’s needs
Model for Ranking Process • Decide and refine criteria to use for ranking • Define list of potential issues • Use a ranking method of choice, identify 2-6 priority issues • Develop an improvement plan / action plan to address the priority issues
Model for Ranking Process • Decide and refine criteria to use for ranking • Define list of potential issues • Use a ranking method of choice, identify 2-6 priority issues • Develop an improvement plan / action plan to address the priority issues Community Health Improvement Plan – Strategic Plan
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