Final priority setting method

The JLA supports an adapted Nominal Group Technique for PSPs choosing their priorities.  One benefit of this technique is that it prevents the domination of discussion by a single person and encourages the participation of less assertive members.  There is no hierarchy between the different participants; no one individual or group's views or experiences are more valid than another’s.

Nominal Group Technique is a well-established and well-documented approach to decision making.  It can be used by groups that want to make decisions quickly, for example, by voting, but want everyone’s opinions to be taken into account.  Each participant reviews the items for discussion and gives their view.  A shared voting or ranking exercise is undertaken with further structured small group discussions followed by ranking or voting.  The ranked orders for each item from each group are totalled, and the priority with the lowest, i.e. most favoured, total ranking is selected as the top priority.

It has been suggested that this technique can be useful when:

  • Some group members are much more vocal than others
  • Some group members think better in silence
  • There is concern about some members not participating
  • The group does not easily generate many ideas
  • Participants are not used to working together
  • The issue is controversial or there is heated conflict.

Three JLA Advisers facilitate the final priority setting process to ensure fairness, accountability and transparency.  The JLA’s facilitation approach is neutral and empowering, and has no influence over the outcomes of the workshop discussions.  The facilitators will ensure that the process takes place and the JLA’s principle of equal involvement of patients, carers and clinicians is upheld.

JLA facilitators are aware that some patient and carer representatives may be less experienced than professional clinicians at contributing to open debate, and are therefore careful to actively include patients and carers and ensure they have opportunities to share their views and experiences.

Who should take part?

Those eligible to take part in a JLA priority setting workshop must have personal or professional experience of the health area in question:

  • Patients or carers with direct experience of the health area being discussed, or representatives from patient support groups, patient charities etc
  • Clinicians – a balance of appropriate clinicians for the health area being discussed, e.g. specialist nurses, consultants or senior registrars, paediatricians, GPs, surgeons, physiotherapists, dieticians, advice line nurses, speech therapists.

It is recommended that a minimum of 12 people and a maximum of 30 are recruited. The more participants, the more difficult it will be for everyone to have their say and come to a consensus. Some people can struggle to participate in larger groups.  The Steering Group should consider if this will cause stress to its particular stakeholder group and either adjust the numbers accordingly or consider having four smaller breakout groups, rather than the usual three.

The Steering Group should agree a list of ideal range of types and numbers of people to attend the final workshop, for the workshop organiser to recruit.  Generally, workshop participants are recruited in a range of ways, for example:

  • through the survey
  • through the Partner organisations and the Steering Group’s extended networks
  • through an open call on social media and via the PSP’s mailing list.

Selection should involve a screening process to ensure an appropriate mix of participants, so that a diverse range of professionals and patient/carers are identified.  It should not be done on a first-come-first-served basis.  The Steering Group should also consider how important it will be to have a variety of geographical areas represented at the workshop, bearing in mind the costs of travel and perhaps accommodation that this will incur.

Clinicians with research interests as part of their role are eligible to take part in the final priority setting workshop, as long as they also treat patients and are currently clinically active.  They will need to declare their research interests.

The JLA considers achieving a balance of clinical and patient viewpoints more important than the representativeness of each participant.  This is important, because most examples of priority setting show “clinicians are more involved than patients in the whole process[8]. Participants are encouraged to share biographical information about themselves and their perspectives of the condition under discussion before the workshop in a Declaration of Interests and Needs document, which is summarised and given to all workshop participants on the day.

Finally, with the JLA Adviser, the Steering Group should decide what their position is on members of the Steering Group being present at the final workshop.  Some Steering Group members may decide they can legitimately be involved as participants, or they may decide that a new set of voices should be brought in to make the final decisions.  They may simply wish to observe.

 

[8] Stewart R and Oliver S (2008) ‘A systematic map of studies of patients' and clinicians' research priorities.’ London: James Lind Alliance