'Prioritizing Health Problems by the National Association of County and City Health Officials' is a marvelous example of a paper on the health system. Through the article, NACCHO intends to provide a guide for prioritizing issues when making decisions in organizations, particularly in the healthcare providers sector. Consequently, the article provides a structured mechanism through which to rank issues that need the health workers’ attention at different times when taking into account the differences in scenarios presented by different needs. To achieve this, the article presents the five most common options for situation-based prioritization and provides guidance on the technique that best meets the needs of healthcare providers including structured instructions for implementation and some examples on application. The association (NACCHO) sets the agenda of the paper by contrasting the practical working environment of most LHD personnel (which involves meeting adverse challenges brought about by emerging health threats like the recurrent H1N1 flu) with the changing economic realities such as inevitable budgetary cutbacks.
This way, the LHD personnel are left with lesser resources to work within an environment that requires more budgetary commitment due to the increasing number of challenges.
In order to address these challenges, NACCHO supposes that creating a system of accountability for government health agencies is a particularly good idea. This need has been met through the establishment of the Public Health Accreditation Board (PHAB). The board has embarked on the continuous development of a voluntary national accreditation program that will review quality issues. The article lists some of the common constraints that face LHD personnel in their work as costs, varying degrees of urgency (with specific attention to highly-urgent situations), impact, and feasibility of programs and missions.
As a result, the task of continuously meeting the quality standards required of the LHD staff is addressed through the work of the PHAB. The Discussion The selection of plans to implement is to be guided by the prioritization accorded to each individual plan. This selection should reflect the order of appropriateness and democratic considerations; which are encouraged through the undertaking of the following set of preliminary steps: Community assessment – The primary role of undertaking this step is to determine the present status of an issue that needs the LHD staffs’ attention and understand the areas that need higher priority when addressing.
PHAB emphasizes the compulsory community health assessment (CHA) before any communities are considered priority targets. Intra-agency assessment – Agencies are required to assess their performance against nationally recognized standards. This helps LHDs to determine the effectiveness of their work and also understand the weaknesses in their efforts to deliver effectively to their immediate communities. Consequently, prioritization can be done based on the weights (ability to most negatively impact the health of the community vis-à -vis the available budget) accorded each issue identified. Clarifying objectives and processes – The LHD leadership is required to ensure that all members involved in effecting certain chosen priority agendas over others have adequate knowledge of the criteria used to prioritize the chosen agenda based on the goals of the LHD unit. Establishing selection criteria – Establishing effective criteria for prioritization of agenda helps to eliminate bias in selection and avoid person-centered processes.
This ensures that each LHD’ s views are reflected in the decision arrived at. The most common prioritization criteria involve either identification of the priority problem or identification of intervention to a problem.
In identifying a potential problem, the specific indicators to look out for include: Cost of investment or return on investment Availability of solutions The impact of the problem Availability of resources needed to address the problem Urgency required The magnitude of the problem The following indicators usually guide the work of LHDs when identifying the appropriate intervention for a specific problem: Expertise to deal with the problem Return on investment Effectiveness of solution Ease of implementation and the consequent maintenance Potential negative consequences Legal considerations Impact on health Feasibility of intervention Prioritization Methods Multi-voting technique – The technique is employed when a long list of issues has to be reduced to a smaller list of more pressing ones.
The method has the advantage of revealing the priority favored by the majority of voters to emerge as a priority in contrast to conducting a single vote that would mask such an issue by elevating a lesser multilevel issue. The process requires the LHDs to vote severally based on a set of rules. The first round of voting involves identifying a number of issues from a laid-out set of potential issues.
The issues that fail to amass a vote count from at least half the number of voters is eliminated in favor of ones that do. Participants then cast votes equivalent to half the updated list of issues, selecting their top priorities based on the new version of the list. This step is repeated until the desired number of issues (predetermined through assessing such issues as budgetary constraints) is reached. Strategy grids – The grids help agencies to focus on addressing issues that are bound to yield the highest results.
It allows for a thoughtful approach towards achieving the best results based on the available limited resources. The initial step involves selecting a set of considerably broad criteria most relevant to the unit. The competing priorities are then assessed based on how well they fit into these criteria. Other basic steps include assessing and labeling the components of each criterion as either high priority/ high feasibility or high priority/ low feasibility through comparative analysis and selecting the overall most impactful issue emerging from both assessment paths (priority and feasibility statuses). Nominal group technique – This technique uses group input to prioritize issues.
It is especially useful when the need to generate many ideas over severe time constraints exists, or when the views of several individuals are needed. It is often a preliminary stage in the multi-voting technique. As such, the actual process of obtaining the information is often superseded by the subsequent voting process of the multi-voting technique. The Hanlon method – The method takes into account available data for computing the feasibility levels of different criteria available to the LHD.
The initial stage involves rating each identified issue on the basis of size/ magnitude against the effectiveness of potential interventions. The outlined issues are then assessed based on the propriety/ suitability, economic sense, acceptability, resources, and legality (PEARL) test. The priority scores are then calculated and they enable the ranking of observed/ identified issues. Prioritization Matrix – The method is most suitable when the unit is obligated to resort to only one of the identified issues or issues that are considered against a large number of criteria. The method requires laying out of a matrix of issues against the available criteria and obtaining cumulative priority scores for the various issues.
The cumulative scores are then assessed based on their magnitudes/ sizes and the highest ones selected leaving out the issues with inferior scores. The method is very accurate despite being viewed as being relatively more complex than the others considered in the article. Conclusion Prioritization techniques are a superb approach for dealing with the challenge of resource allocation and selection of priority actions. The techniques not only save the LHDs from the agony of dealing with goal refocusing but also help in laying out retraceable decision-making processes; which apparently enhances accountability and transparency.
The techniques focus on the greater good of the community by emphasizing prioritization based on the sound criteria of available resources against the viability of the solution.
ReferencesNational Association of County & City Health Officials. First Things First: Prioritizing Health Problems. (n.d.). PDF.