Ways of working
Priority Setting Partnerships in which patients and clinicians agree research priorities are a new idea, but they can learn from partnerships set up for similar purposes.
As set out more fully below, partnerships can be evaluated in terms of:
Degrees of involvement
- the degree of involvement of patients and clinicians in planning and decision-making
- moral, ethical, and practical principles for involving the members
- standards of good practice recognised for priority setting more widely
: the minimum degree of involvement in research is simply being consulted about it, while collaboration implies a more equal status of participants. Greatest involvement is being in control.
To read more about the theory of degrees of involvement, click here.
Degrees of involvement were first distinguished in an analysis of citizensí involvement in American urban planning
. In Arnsteinís 'ladder of involvement'
a prior step to any potential influence is being informed about what is happening. Consultations that capture public opinions may be through surveys, neighbourhood meetings or public enquiries. Closer collaboration may be tokenistic placation or meaningful partnership. Delegated power (and its associated accountability) and citizen control are the two top rungs in the ladder where citizens have a role in making decisions.
For more on Arnstein's ladder of involvement, click here
Evaluating priority setting partnerships in these terms is useful, both at the planning stage and later, as it helps participants to be clear about and reflect on their roles. Were their views and opinions invited appropriately? Were they partners sharing decisions? Did they feel some control over the process?Principles and indicators of successful involvement
: more detailed suggestions for how to involve patients and clinicians have been adapted from a study of good practice for involvement in research
. These include:
Standards for priority setting
|The roles of patients and clinicians in priority setting are agreed within the partnership.||The roles of patients and clinicians in the partnership were documented|
|Patients and clinicians are involved in decisions about how people are both recruited and kept informed about the progress of the priority setting.||Patients and clinicians gave advice to the partnership on how to recruit people for priority setting. Both groups gave advice to the partnership on how to keep participants informed about the progress of the priority setting.|
|Patient and clinician involvement is described in priority setting reports. ||The involvement of patients and clinicians in the priority setting reports and publications was acknowledged. Details were given in the priority setting reports and publications of how patients and clinicians were involved in the priority setting process|
|Priority setting decisions are available to patients and clinicians, in formats and in language they can easily understand.||The distribution of the priority setting decisions to relevant patient and clinician groups was in appropriate formats and easily understandable language. Patients and clinicians involved in the priority setting gave their advice on the choice of methods used to distribute the priority setting decisions.|
: assessing whether the ways of working meet recognised standards for priority setting can include asking the following questions:
- Is there a strong commitment to engaging a full range of relevant stakeholders using multiple methods, with stakeholders well satisfied by the processes?
- Is there a clear plan that is followed in order to enhance trust and confidence in the processes?
- How is information found, collated and presented to the decision-makers; and what is considered lacking?
- Are decisions based on clear reasons?
- Is there a formal mechanism for reviewing decisions and addressing disagreements constructively?
These questions for assessing ways of working are based on research about priority setting for health services.
Important processes for judging success include:
- Stakeholder engagement: a strong commitment to engaging a full range of relevant stakeholders using multiple methods, with stakeholders well satisfied by the processes
- Explicit processes: adhering to a clear plan in order to enhance trust and confidence in the processes
- Information management: how information was found, collated and presented to the decision-makers; and what was considered lacking
- Consideration of values: with decisions based on reasons grounded in clear value choices, and those reasons made explicit
- Revision or appeal mechanism: a formal mechanism for reviewing decisions and addressing disagreements constructively
to read about how these questions were developed.
Arnstein, Sherry R. "A Ladder of Citizen Participation," Journal of the American Planning Association, Vol. 35, No. 4, July 1969, pp. 216-224.
Boote J, Barber R, Cooper C (2006) Principles and indicators of successful consumer involvement in NHS research: results of a Delphi study and subgroup analysis. Health Policy, 75 (3), 280-297
Sibbald SL, Singer PA, Upshur R and Martin DK. Priority setting: what constitutes success? A conceptual framework for successful priority setting. BMC Health Services Research 2009, 9:43 doi:10.1186/1472-6963-9-43