Squaring the circle: a priority-setting method for evidence-based service development, reconciling research with multiple stakeholder views

Abstract

BackgroundThis study demonstrates a technique to aid the implementation of research findings through an example of improving services and self-management in longer-term depression. In common with other long-term conditions, policy in this field requires innovation to be undertaken in the context of a whole system of care, be cost-effective, evidence-based and to comply with national clinical guidelines. At the same time, successful service development must be acceptable to clinicians and service users and choices must be made within limited resources. This paper describes a novel way of resolving these competing requirements by reconciling different sources and types of evidence and systematically engaging multiple stakeholder views.MethodsThe study combined results from mathematical modelling of the care pathway, research evidence on effective interventions and findings from qualitative research with service users in a series of workshops to define, refine and select candidate service improvements. A final consensus-generating workshop used structured discussion and anonymised electronic voting. This was followed by an email survey to all stakeholders, to achieve a pre-defined criterion of consensus for six suggestions for implementation.ResultsAn initial list of over 20 ideas was grouped into four main areas. At the final workshop, each idea was presented in person, visually and in writing to 40 people, who assigned themselves to one or more of five stakeholder groups: i) service users and carers, ii) clinicians, iii) managers, iv) commissioners and v) researchers. Many belonged to more than one group. After two rounds of voting, consensus was reached on seven ideas and one runner up. The survey then confirmed the top six ideas to be tested in practice.ConclusionsThe method recruited and retained people with diverse experience and views within a health community and took account of a full range of evidence. It enabled a diverse group of stakeholders to travel together in a direction that converged with the messages coming out of the research and successfully yielded priorities for service improvement that met competing requirements.

Reconciling patient and provider priorities for improving the care of critically ill patients: A consensus method and qualitative analysis of decision making

“…For example, the James Lind Alliance has facilitated over 70 partnerships to develop prioritized lists for health research. However, individual stakeholder groups may nevertheless have distinct priorities and reconciliation is necessary to allow for focused action . To the best of our knowledge, the process of reconciling the priorities of different stakeholders has received little attention and needs to be evaluated .…”

“…Ideas for service improvement were presented at a consensus workshop and through a series of “idea champions.” Idea champions recognized the value of the idea and attempted to convey this value to others. The researchers identified individuals to champion specific ideas a priori, whereas idea champions (akin to priority champions ) naturally evolved during the round‐table discussions in our consensus workshop, helping to galvanize panellists to consensus. The use of idea champions needs to be carefully managed and monitored to mitigate the introduction of biases during group decision making, such as “groupthink,” which occur in situations where individuals avoid raising controversial issues .…”

“…The use of idea champions needs to be carefully managed and monitored to mitigate the introduction of biases during group decision making, such as “groupthink,” which occur in situations where individuals avoid raising controversial issues . Anonymous rounds of in‐person voting and moderation of the discussion by a trained and experienced facilitator (both used in our study) are two strategies to manage this risk …”

“…For example, patients and families have recently been involved in establishing priorities to inform clinical care in a variety of health conditions including diabetes, stroke, dialysis and eczema . However, little is known about how to reconcile the priorities of different stakeholder groups into a single patient‐centred prioritized list that is actionable within the health‐care system . It is not difficult to imagine that patients and health‐care providers may have different priorities .…”

“…[15][16][17] However, little is known about how to reconcile the priorities of different stakeholder groups into a single patient-centred prioritized list that is actionable within the health-care system. 18 It is not difficult to imagine that patients and health-care providers may have different priorities. 10 For example, patients might consistently rank symptom management or preservation of sleep as a higher priority for improvement than physicians.…”