Final priority setting approaches
The JLA supports an adapted Nominal Group Technique for PSPs choosing their top 10 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.
Nominal Group Technique is a well-established and well-described 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 contributor 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
- All or some group members are new to the team
- The issue is controversial or there is heated conflict.
Overall, the JLA has developed a neutral style of facilitation, adopting a non-prescriptive approach to small group discussion about prioritisation, but maintaining the ranking approach across small groups. This helps to ensure that groups develop their own ways of working and make their decisions without being influenced by the JLA.
The JLA method for final workshops aims to prevent the domination of discussion by a single person and encourages the participation of less assertive group members.
The JLA Adviser facilitates the final priority setting process to ensure transparency, accountability and fairness. It is recommended that a JLA Adviser is used to facilitate each of the small groups.
It is important that patients, carers and clinicians can contribute equally. As such, membership of the small discussion groups should be determined in advance, to ensure an even mix of both groups.
Facilitators need to be aware that some patient and carer representatives may be less experienced than professional clinicians at contributing to open debate, and should therefore be careful to actively include patients and carers and ensure they have opportunities to share their views and experiences.
Information such as participant biographies and a clear structure for discussion and decision making must be sent to participants ahead of the workshop to help with this process. There is no hierarchy between the different participants; no one group's views or experiences are more valid than another’s.