Priority Settings for CHA Wichita, November 28, 2012

1. Priority Settings for CHAWichita, November 28, 2012 Gianfranco Pezzino Senior Fellow and Strategy Team Leader Kansas Health Institute

2. 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

4. 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

5. Obesity Alzheimer disease IMR Cancer Vaccine-preventable disease Unintentional injuries Cardio-vascular disease Foodborne disease Mental illness HIV infection Oral health

6. Report • What are “your” priorities? • How did you come to this conclusion? • Could there be something missing?

7. Do we have a consensus? • If not, what would it take to get to a consensus?

8. 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

9. Vision:Health People in Healthy Communities. As a community of professionals who, through a commitment to education, innovation, leadership in crises, respect for our citizens and research solutions for health problems, we strive to make XXX County residents the healthiest people in the nation. A Good Starting Point in Prioritization Process

10. Vision:Health People in Healthy Communities. Mission: Promote Physical and Mental Health and Prevent Disease, Injury, and Disability. Working together and committed to excellence, we protect and promote the health of our citizens through prevention, science, and the assurance of quality health care delivery. A Good Starting Point in Prioritization Process

11. Preliminary Step • Define process: • How exactly is ranking going to be decided?

12. Example of Ranking Process • Decide and refine criteria to use for ranking • Decide relative significance of each criterion (weights) • Define list of potential issues • Using scoring system from 1 to +10, rank each issue • Average score for each issue is computed • Multiply by weighting score, if available • Place totals in rank order

13. Example of Ranking Process • Decide and refine criteria to use for ranking

14. 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 at this stage

15. Commonly Used Criteria • How many people are affected? • How severe is the issue? • How feasible is an intervention to attack this problem? • What is the level of concern in the community?

16. Additional Possible Criteria • Degree of control of PH system • Issue affects disproportionately minorities or disadvantaged groups (“disparity”) • What are the consequences of not intervening? • What are the potential negative impacts of addressing the problem?

17. Additional Possible Criteria, cont. • What do policymakers think? Do they support this issue? • What assets and resources can partners bring to address this issue? • How long will it take to reach an outcome?

18. Additional Possible Criteria, cont. • Are there strategies that have been shown to effectively address this issue? • What has been tried before? What were the barriers and successes of those attempts?

19. How to Reach Consensus on Criteria • Involve the stakeholders in the process • Nominal group (see below) • Can start from a provided list of criteria or leave options open

20. Hands-on Activity (5 minutes) • At each table, discuss and select criteria to use when ranking health issues, using the provided form • Be ready to present your list in 5 minutes

21. Refine Selection Criteria • After selection criteria are identified, can refine the list, e.g.: • Provide parameters to assess each criterion • Use weights

22. Examples of How To Assist In Ranking Process • A. This health issue affects: • very few people • less than half of the people • half the people • a majority • everybody • B. The pain, discomfort, and/or inconvenience caused by this health issue is: • none • little • appreciable • serious • very serious

23. Weights • Value each criterion differently in final decision • Essentially, it is ranking the criteria • Ask group to determine the relative significance of each criteria, e.g.: • Each member places a value on each criteria 1 to 5 • Values are averaged • Averages become the weights used in final ranking process

24. Hands-on Activity (3 minutes) • Using the list of criteria provided, rank the order of importance of each criterion (i.e., its “weight”) • After each of you has finished, calculate the average weight for your table of each indicator: Sum of weights from each individual Number of individuals

25. Example of Ranking Process • Decide and refine criteria to use for ranking • Define list of potential issues

26. Why Compiling a List of Potential Issues? • People need to know WHAT to rank and prioritize • During CHA planning, you decided what items to include in CHA-CHIP => data profile • If data profile contains relatively few measures, that can be your list • If data profile contains lots of measures, you may want to develop shorter list

27. Nominal Group Technique • Group decision-making method • Quick decision with everybody’s opinion considered • Can be used at multiple stages of the priority ranking process • Steps: • Every member expresses preferences • Duplicate solutions removed • Members proceed to select solutions

28. List Potential Issues: Nominal Group Technique • Call attention to information on data profile (primary and secondary data) • Decide whether to limit list to issues on profile or keep list open • Option 1: • Each member in turn states aloud one issue • Facilitator records it on the flipchart • No discussion is allowed, not even questions for clarification

29. Nominal Group, cont. • Continue until all members pass or for an agreed-upon length of time • Discuss, consolidate list • Each member lists the top XX issues (e.g., 10, 20, etc.) • Option 2: • Each member silently writes list of XX issues on paper • Discuss, consolidate list • Votes are counted, XX finalists (e.g., 10) selected • These is the list of health issues that will be prioritized

30. Hands-on Activity (5 minutes) • Refer to the handout from KHM • Imagine that you have decided to use for your CHA all the KHM health indicators • Spend a few minutes thinking which 10 indicators should be ranked • Write the 10 selected indicators on the provided form

31. Example of Ranking Process • Decide and refine criteria to use for ranking • Define list of potential issues • Using scoring system from 1 to +10, rank each issue • Average score for each issue is computed • Multiply by weighting score, if available • Place totals in rank order

32. Recap • Now you have: • A list of issues to rank • Criteria and weights for ranking them • The next step is going through each of the issues and rank them using those criteria

33. Priority Setting –Issue Individual Score

34. Priority Setting – Issue Aggregate Score

35. Priority Setting – Ranking Results

36. 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

37. Moving On • Priority list should be used to develop CHIP • Group will decide how many issues to include in CHIP (3 to 6)

38. Kansas Health Institute Information for policy makers. Health for Kansans.