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Section 23. Developing and Using Criteria and Processes to Set Priorities

Tool #1: Some Decision-Making Processes

From a PowerPoint by Melissa Biel of Biel Consulting.

1. Relative worth. Each participant receives a fixed number of points (for example, 100 points). These points can be distributed among the items to be prioritized in whatever way the participant desires. Participants can distribute points in a number of ways:

  • Give all points to a single, very important item.
  • Distribute points evenly among all items (if none is more important than another).
  • Distribute some points to some items, no points to other items.
  • In the tabulation, items are given priority ranking according to the total points the group assigns.

2. Forced ranking.

  • Needs are ranked separately on a scale.
  • For example, if there are ten items, the most important item is assigned a "1," the second most important item is assigned a "2," and so on down to the least important item, which receives a "10.“
  • In the tabulation, the item that receives the lowest number of points is assigned highest priority, the item that receives the second lowest number of points receives second priority, and so on.

3. Delphi method.

  • The coordinating group assembles participants with knowledge and experience in the issue to be addressed.
  • Needs are identified and presented to participants for feedback. A deadline for returning responses is given.
  • The coordinating group records all responses and distributes them to participants.
  • Participants are asked to review the responses and add additional ideas or delete ones considered not important or not feasible. Participants then choose the three or five most important ideas and rank these in descending order of importance.
  • Results of the rankings are collated and analyzed.
  • Findings are returned to participants who are again asked to rank the top three or five preliminary priorities. Additional rounds may be implemented if necessary.
  • Results are collated and categorized. An overall ranking is determined.

Delphi enables participants to examine group responses with each succeeding round, and to alter their views or to provide a rationale for sustaining a divergent opinion.

4. Hanlon method. There are three central features of the method:

  • Focuses on identifying explicit criteria to be considered in setting priorities.
  • Ability to organize factors into groups that are weighted relative to each other.
  • Allows for modification and individual scoring of factors.

Criteria for scoring of factors and subsequent priority setting include:

  • Size of the problem
  • Seriousness of the problem
  • Estimated effectiveness of intervention(s) under consideration
  • PEARL (i.e., propriety, economic feasibility, acceptability, resource availability, and legality)
    • P = propriety: is an intervention suitable?
    • E = economics: does it make economic sense to address the problem?
    • A = acceptability: will this community accept an emphasis on this problem and will they accept the proposed intervention?
    • R = resources: are resources available?
    • L = legality: do the current laws allow the intervention to be implemented?

5. Delbeq method.

  • The Delbeq "Two Step" method involves the use of a nominal group process to develop a detailed set of priority issues, and the subsequent sharing of issues and development of a consolidated list of priorities.
  • The term "nominal group" is used to underline the highly controlled dimension of the process.
  • In the first stage, participants are asked to privately record their major concerns on a sheet of paper.
  • Facilitators then go around the group to elicit their priority concerns. This is usually done anonymously, by asking for a limited list (2 or 3) of priority concerns to be handed in to facilitators. These are recorded on a white board.
  • An alternative is to hold a "round robin" where priority concerns are elicited from participants one at a time. No comment is permitted during this stage.
  • In the second stage, facilitators take participants through a controlled discussion; first to clarify priority concerns, and then to consolidate common issues.
  • Finally, for health planning efforts where large lists of priority concerns are typically generated, participants may go through a ranking process to limit the number of potential options.
Phil Rabinowitz