ACHI Audio Conference

Priority Setting for
Community Benefit
Melissa Biel, RN, DPA
Biel Consulting
July 9, 2009

Session Objectives
 Discuss the process of selection of

community programs based on
community health needs.
 Understand and apply a variety of

methods for setting community
benefit priorities based on identified
community needs.

Community Benefit
CHA/VHA Definition
 Encompasses a full range of services

and activities provided by nonprofit
hospitals to address the symptoms and
causes of health-related concerns.
 A planned, managed and measured
approach to meeting identified
community health needs.
 Implies collaboration with the community

to benefit residents by improving health
and quality of life.

Community Needs Resources Financial – Staff – Time .

.asacb.Community Benefit Goal (ASACB – www.org) To make optimal use of limited charitable resources to address unmet health-related needs.

Community Benefit Planning and Implementation  Reduce health disparities  Reduce health care costs  Enhance community problem solving capacity .

From Assessment to Plan Needs Assessment  Priorities  Programs  Community Benefit Plan .

.  Show evidence of high prevalence or severity of health concerns.Needs Assessment  Communities with DUHN (disproportionate unmet health need) are identified and documented in the community needs assessment.  Identify geographic areas where residents are faced with multiple health problems and have limited access to health care.

From Assessment to Plan  Needs Assessment Priorities  Programs  Community Benefit Plan .

and one of the most neglected. .  Establish explicit criteria and process used by community benefit committee and staff to select priority program areas of focus.Priorities (1)  Priority setting for the selection of program content areas is one of the most important steps in the community assessment process.

. and evidence-based approach is needed. deliberate.Priorities (2)  Most high quality community assessments produce a relatively large number of health concerns that could be viewed as important.  A more rational. if not priorities.

Priorities (3)  The selection of priorities can be driven by factors ranging from who advocates most vigorously. or which stakeholders have more influence and resources to invest. .  This approach yields priorities. but they may not represent the most effective use of limited resources.

Priorities (4) Priority setting should be based upon:  a clearly articulated set of criteria  areas where the needs are greatest  where the potential for producing measurable outcomes is highest  where community partners are most invested in positive results .

Criteria and Process for Priority Setting  Develop a formal process and use explicit criteria to select program priorities. who should play a significant role in determining the selection criteria.  The process should include diverse community stakeholders. .  Document the rationale for not addressing significant health issues identified in the community assessment.

Community Benefit Priority Setting  Process  Process  Process  Refrain from jumping to solutions .

Western Consortium for Public Health . K. (1996). Setting Priorities to Address 21st Century Realities: A Review of Existing Approaches.Priority setting methods  Relative Worth  Forced Ranking  Delphi Method  Hanlon Method  Delbeq Method  Source: Barnett.

very important item. These points can be distributed among the items to be prioritized in whatever way the participant desires. In the tabulation. Distribute points evenly among all items (if none is more important than another). no points to other items. Distribute some points to some items.Relative Worth     Each participant receives a fixed number of points (for example. Participants can distribute points in a number of ways: Give all points to a single. . 100 points). items are given priority ranking according to the total points the group assigns.

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

Delphi Method (1) 1.The coordinating group assembles participants with knowledge and experience in the issue to be addressed. A deadline for returning responses is given. . The coordinating group records all responses and distributes them to participants. 3. Needs are identified and presented to participants for feedback. 2.

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. 5.Delphi Method (2) 4. Results of the rankings are collated and analyzed.

Delphi Method (3) 6. 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. . An overall ranking is determined.Results are collated and categorized. and to alter their views or to provide a rationale for sustaining a divergent opinion. 7. Delphi enables participants to examine group responses with each succeeding round.

Hanlon Method (1) There are three central features of the method: 1. Focuses on identifying explicit criteria to be considered in setting priorities. Ability to organize factors into groups that are weighted relative to each other. . 2. 3. Allows for modification and individual scoring of factors.

Hanlon Method (2) 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. acceptability.e. economic feasibility. and legality) . resource availability. propriety..

More on PEARL  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? .

. 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.Delbeq (1)  The Delbeq "Two Step" method involves the use of a nominal group process to develop a detailed set of priority issues.

This is usually done anonymously. by asking for a limited list (2 or 3) of priority concerns to be handed in to facilitators. .Delbeq (2)  In the first stage. These are recorded on a white board.  Facilitators then go around the group to elicit their priority concerns. participants are asked to privately record their major concerns on a sheet of paper.

and then to consolidate common issues. . first to clarify priority concerns.Delbeq (3)  An alternative is to hold a "round robin" where priority concerns are elicited from participants one at a time.  In the second stage. facilitators take participants through a controlled discussion. No comment is permitted during this stage.

Delbeq (4)  Finally. . participants may go through a ranking process to limit the number of potential options. for health planning efforts where large lists of priority concerns are typically generated.

Tools  ACHI Community Health Assessment Toolkit  ASACB User’s Guide www.org  Healthy People 2010 Toolkit – Priority Setting Worksheet http://www.healthypeople.asacb.gov/state/toolkit/ .

CA . San Diego. CA  Scripps Health. Whittier.Examples  Presbyterian Intercommunity Hospital.

PIH  Summary of indicators  Priority health template  Value and probability grid (alternative = importance and feasibility) .

pages 4-8 www.pdf .scripps.Scripps Health  Community Benefit Plan.org/assets/documents/commu nitybr09.

From Assessment to Plan  Needs Assessment  Priorities  Programs Community Benefit Plan .

Community Benefit Plan (1) The Community Benefit plan is a tool for you to connect the needs assessments. program selection and accomplishments. priority setting. Use it to:  Respond to internal and external pressures  Show your efficient use of limited charitable resources .

unmet needs in your community. support community relations The Plan outlines what you are going to do to meet the identified. .Community Benefit Plan (2)  Support your plan to improve community health  Promote accountability and communication (transparency)  Build public trust.

 Do outline the priority setting process. . including criteria and decision makers.Community Benefit Plan (3)  Do include an overview of the needs assessment.

Community Benefit Plan (4)  Do identify the priority programs.  Do acknowledge that not all priorities can be addressed. .

com 562-496-2462 .Questions? Melissa Biel melissabiel@bielconsulting.

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