Prioritising change projects healthcare

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A third reviewer RF verified independently the proposed criteria against the ones reported by the included studies. This represented an opportunity to review the criteria, suggest refinements, avoid redundancy and propose new criteria.

This was followed by a meeting to resolve disagreements through consensus and finalize the criteria list. Figure 1 shows the study flow diagram which summarizes the selection process. Out of the 33, citations identified through the electronic databases search, 10 papers met our inclusion criteria. We provide a detailed tabular description of each of the 10 included prioritization approaches in Additional file 4. The general characteristics of the 10 distinct approaches for prioritizing guideline topics described in the papers are reported in Table 1.

All of the identified prioritization approaches focused on prioritizing guideline topics; none on prioritizing guideline recommendation questions or outcomes. None of the approaches were specific to the update or adaptation of guidelines; all focused on the de novo development of practice guidelines. Table 2 shows steps of the development process of each of the 10 included approaches for prioritizing guideline topics. The two steps most frequently reported to be used in the development process were: reviewing the grey literature e.

Patient and public involvement was reported to be used in the development of only one prioritization approach [ 14 ]. Two studies followed all of the steps in the development process and were thus the most comprehensive and detailed [ 17 , 20 ].

Table 3 shows the aspects proposed to be addressed when prioritizing guideline topics. Only one study highlighted the need to conduct prioritization during the various steps of guideline development, such as prioritizing the target audience, scope of guideline, questions of potential interest, effort of synthesizing evidence, recommendations, and recommendations for research [ 18 ].

Table 4 represents the steps proposed for generating an initial list of topics when prioritizing guideline topics. All of the studies incorporated the use of prioritization criteria as an aspect of the prioritization approach. Table 5 shows the proposed types of stakeholders to involve in prioritizing guideline topics and the method for their involvement. Three studies covered the highest number of aspects of prioritization, that is four out of the five aspects [ 8 , 18 , 20 ].

Decide who will oversee the process e. Apply specific criteria and use a transparent and systematic process to guide the suggestions of guideline topics. The studies included a mean of 12 criteria range 5— We derived from the criteria a common framework of guideline prioritization criteria and of the domains they fall under.

The framework is composed of 20 prioritization criteria clustered in six domains Table 6 including: 1 disease-related factors; 2 interest; 3 practice; 4 guideline development; 5 potential impact of the intervention; and 6 implementation considerations. Proposed types of stakeholders to involve in prioritizing guideline topics and the method for their involvement.

Our study aimed to identify and describe prioritization approaches that have been suggested in the development of health practice guidelines. We identified 10 prioritization approaches seven for clinical practice, one for public health, one for WHO healthcare recommendations, and one for all three fields. There were variabilities in the steps followed to develop the approaches, in the aspects proposed to be addressed when prioritizing guideline topics, and in the prioritization criteria.

Stakeholder involvement and the use of prioritization criteria represented key aspects of most of the prioritization approaches. There is a global movement calling to increase the engagement of diverse stakeholders consumers; health service providers; policy makers; and researchers in developing research agendas and determining research priorities [ 21 , 22 ]. The net benefit of this involvement needs to be further examined in developing prioritization approaches, as very few studies considered this aspect [ 23 , 24 ].

We developed a common framework of prioritization criteria that captures all of the criteria reported by the included studies. In the field of guideline development, recent documents on when and how to develop practice guidelines reported only examples of deciding which guidelines should be developed e. A recent systematic review of the literature addressed prioritization but was limited to the update of health decision-making tools, one of which was guidelines [ 25 ].

Consistent with our findings, this systematic review found that the studies proposing an overall development strategy of guidelines did not provide a detailed description of the prioritization criteria used [ 25 ]. This study has several strengths. First, it responds to calls by researchers and health professionals globally emphasizing the importance of setting priorities in guideline development [ 26 , 27 ].

To our knowledge, this is the first systematic review to describe prioritization approaches in the development of health practice guidelines. Another strength of the present study is that we used a rigorous and transparent process in its conduct comprehensive search strategy, duplicate and independent selection, and duplicate and independent data abstraction [ 28 ]. Finally, we followed an iterative process of drafting and revision to create a common framework of prioritization criteria that captures all of criteria reported by each of the ten included study.

This represents a step towards standardizing the terminology for prioritization and enhancing the clarity of the criteria for decision-making. One potential limitation of the study is that we did not search the grey literature and therefore we could have missed on potentially relevant information.

We described 10 approaches in the development of guidelines. The review findings can assist clinicians, funders, policymakers, and other stakeholders seeking to develop health practice guidelines in prioritizing topics to be addressed. It might be challenging to provide specific guidance on which approach to use given the variability in the processes followed to develop the approaches.

However, guideline developers can choose the prioritization approach and criteria that best fit their needs. The wide variability in the identified prioritization approaches necessitates that researchers develop standardized and validated priority setting tools in the development of health practice guidelines.

There is also a need to develop methods for prioritization of questions and outcomes for guidelines projects. Researchers are encouraged to provide guidance on the conduct and reporting of studies on prioritization approaches.

Further rigorous methodological research is required to assess the effectiveness, efficiency and transparency of the identified approaches.

This kind of evaluation research would lead to a better understanding of potential facilitators and barriers to prioritization. Furthermore, and because all of the included approaches were developed by researchers from middle- and high-income countries, future studies can focus on the effectiveness of the suggested approaches in low-income countries. It is also essential to evaluate the impact of those approaches on resource allocation and on clinical outcomes.

We would like to thank Ms. Lama Hishi for her contribution to the search strategy and title and abstract screening and Dr. Ahmed Ali for his contribution to the title and abstract screening. AEH coordinated the study throughout. All authors critically revised the manuscript and approved the final version. The lead author EAA affirms that this manuscript is an accurate and transparent account of the reported study and that no important aspects of the study have been omitted.

The funder was not involved in the study design, data collection, analysis, and interpretation, or in writing the manuscript. EAA is an author of one of the included papers. He was not involved in the study selection and data extraction processes. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Supplementary information accompanies this paper at Published online Oct Amena El-Harakeh , 1, 2 Rami Z.

Akl 1, 2, 6, 7. Rami Z. Elie A. Author information Article notes Copyright and License information Disclaimer. Akl, Phone: 1 , Email: bl. Corresponding author. Received Jul 10; Accepted Sep Associated Data Supplementary Materials Additional file 1. Study protocol. The study protocol detailed the methodology of the systematic review. Additional file 2. Search strategy. Additional file 3.

Framework of prioritization criteria in the development of health practice guidelines. The common framework of prioritization criteria captured all of the criteria reported by each included study. Additional file 4. Detailed findings of the included papers on the development processes of the prioritization approaches and the aspects to be addressed when prioritizing guideline topics.

This represents a detailed tabular description of each of the 10 included prioritization approaches. Abstract Background Given the considerable efforts and resources required to develop practice guidelines, developers need to prioritize what topics and questions to address. Results Our search captured 33, unique citations out of which we identified 10 papers reporting prioritization approaches for guideline development.

Conclusions We described 10 prioritization approaches in the development of health practice guidelines. Keywords: Guidelines, Methodology, Priority setting, Prioritization approaches, Health priorities, Research prioritization, Guideline development. Background The development of high-quality guidelines is a rigorous and complex process that requires an average of two to three years per guideline [ 1 ].

Methods Our study design consisted of a systematic review of the health literature to identify prioritization approaches in the development of health practice guidelines. We excluded reviews but assessed all of the addressed approaches for potential eligibility. The description of the approach should be thorough enough to allow for reproducibility at least one section dedicated to that description. We excluded papers describing prioritization exercises conducted during guideline development without providing a detailed description of the process used to develop the prioritization approach.

We also excluded papers describing individual prioritization items or criteria. In addition, we excluded papers where the focus of the prioritization approach was different from the guideline development process e. Study selection Teams of two reviewers screened in duplicate and independently all titles and abstracts of identified citations for potential eligibility. Data synthesis Due to the nature of data, we synthesized the findings in a semi-quantitative way.

Results Study selection Figure 1 shows the study flow diagram which summarizes the selection process. Open in a separate window. General characteristics The general characteristics of the 10 distinct approaches for prioritizing guideline topics described in the papers are reported in Table 1. Table 1 General characteristics of the approaches for prioritizing guideline topics. De novo. Development process Table 2 shows steps of the development process of each of the 10 included approaches for prioritizing guideline topics.

Table 2 Steps of the development process of the approaches for prioritizing guideline topics. Aspects of prioritization Table 3 shows the aspects proposed to be addressed when prioritizing guideline topics. Table 3 Aspects proposed to be addressed when prioritizing guideline topics.

Paper When to conduct prioritization? How to generate an initial list of topics? What criteria to use? What stakeholders to involve? Table 4 Steps proposed for generating an initial list of topics when prioritizing guideline topics.

Collect information on patient priorities from representative groups and the literature. Group topics by themes and accept that some might be arbitrary. Oxman, [ 15 ] Not reported Ketola, [ 16 ] 1. Need for a new guideline arises in a specialist society or other source.

Reveiz, [ 17 ] A thematic team experts in the field and methodological consultant would suggest three to five clinical topics that could potentially be selected for developing a clinical practice guideline. Atkins, [ 18 ] 1. Survey clinicians, experts, and patients for candidate topics. Create a list of topics using formal or informal e. Allow stakeholders to comment on scope and specific questions. Identify issues arising from new and emerging technologies and treatments.

Reddy, [ 19 ] Not reported Mounesan, [ 20 ] 1. Topic identification should be done separately for: prevention, diagnosis and treatment.

Table 5 Common framework of the guideline topics prioritization criteria and their respective domains. When asked how they would know that the priority setting process had been a success, workshop participants identified both outcome and process parameters Table 4. In either case, key marks of its success were whether the process were perceived to be an improvement over past priority setting initiatives and whether it were implemented in subsequent iterations of priority setting.

Outcome parameters focused on the effects of priority setting on organizational priorities and budget, on staff, and on the community. Effects on staff involved an evaluation of the impact of priority setting on staff satisfaction and morale, organizational recruitment and retention initiatives, and overall understanding of new priorities across the organization.

Effects on the community focused on how external stakeholders, including members of the public, regional partners, health care peers e. Process parameters focused on the efficiency and fairness of the priority setting process. Efficiency of the priority setting process could be evaluated in terms of whether priority setting improved institutional capacity for allocating resources and making priority setting decisions, and whether stakeholders and decision-makers felt that the priority setting process provided a worthwhile return on the time invested to set priorities.

Fairness of the priority setting process could be evaluated in terms of whether stakeholders understood and felt engaged in the priority setting process, whether priority setting decisions were justified and seen to be reasonable, and whether 'winners' and 'losers' both felt that they had been fairly treated. It was interesting to us that, although A4R was presented as an ethical framework for fair priority setting, workshop participants did not specifically identify conformity with its conditions as a parameter of success related to fairness.

The importance of these conditions is clearly evident, however, among the fairness considerations they cited as well as the process elements they identified as key to setting priorities. Moreover, we had been invited to work with these executive teams precisely because they were seeking an ethical framework through which to improve how they set priorities in their organisations. This suggests to us that A4R was seen by workshop participants primarily as an ethical framework for process design rather than for the evaluation of priority setting processes ex post facto.

Our findings from these three priority setting workshops illuminate the complex challenges faced by decision-makers in managing scarce health care resources. The range of criteria identified in the workshops provides insight into the competing goals e. This is consistent with previous findings that efficiency considerations or simple technical solutions have only limited influence on decision-making and are not sufficient alone to guide priority setting decision-making [ 8 , 17 , 24 , 25 ].

Given the range of interested stakeholders and competing values, our findings underscore the importance of procedural fairness to secure socially acceptable priority setting decisions and to ensure public accountability [ 8 , 18 , 26 ]. This suggests that a fair process model like A4R may be particularly suitable to help decision-makers set legitimate and fair clinical service priorities. Although we report only on three health care organizations, the organisations were all academic health science centres facing similar resource challenges.

Consensus around priority setting criteria and processes emerged independently among workshop participants in their large and small group discussions. However, this does not mean that these findings are exhaustive of the priority setting criteria that might be relevant for setting clinical service priorities e.

Moreover, although our approach was based on the notion that fair priority setting requires a normative grounding in procedural justice — in this case, A4R — this does not mean that these findings are normatively 'right' for clinical service priority setting in all health care organisations. An evaluation of the normative 'rightness' depends to some extent on the specific institutional circumstances under which priority setting is taking place, the stakeholders who are affected, and the strategic goals that are being pursued.

Experience shows, moreover, that the conditions of A4R are sufficiently general to guide fair priority setting in various institutional settings [ 9 , 16 , 20 , 27 ]. Thus, decision-makers in other health care organisations may draw lessons from these workshops to operationalise fair priority setting processes that reflect the particularities of their institutional circumstances and ensure accountability for the reasonableness of their clinical service priorities. Our experience shows that, from the perspective of Board members and senior leaders, our practical approach using A4R offers useful guidance for developing fair and publicly accountable priority setting processes under resource constraints.

However, alternative priority setting approaches may also be beneficial. For example, program budgeting and marginal analysis, an economics-based approach, has been used with senior health care administrators in Canada and elsewhere to improve how priority setting optimises health and non-health benefits within available resources [ 13 ].

A comparison of priority setting approaches has not been done, however preliminary work has begun to explore a more interdisciplinary priority setting approach Gibson JL, Mitton C, Martin DK, Donaldson C, Singer PA, manuscript submitted [ 21 ].

Despite these possible limitations, the lessons we report here fill an important gap in the literature about the criteria, processes, and parameters of success decision-makers would use to set priorities using an ethical framework. We expect that decision-makers in other health care organizations may find themselves in the workshop participants' experience of priority setting and may use these findings as a basis for discussing how they could enhance the fairness and public accountability of their own priority setting processes.

Decision-makers seek pragmatic ways to set priorities fairly in strategic planning, but find limited guidance from the literature. We facilitated workshops for board members and senior leadership at three organizations to assist them in developing a strategy for fair priority setting.

Health Policy. Article PubMed Google Scholar. Article Google Scholar. Google Scholar. Healthcare Management Forum. Holm S: Developments in Nordic countries — goodbye to the simple solutions. Edited by: Coulter A, Ham C. Journal of Health Services Research and Policy. Cookson R, Dolan P: Principles of justice in health care rationing. Journal of Medical Ethics. Emanuel EJ: Justice and managed care: four principles for the just allocation of health care resources.

Hastings Center Report. Mooney G: Vertical equity in health care resource allocation. Health Care Analysis. Mitton C, Donaldson C: Setting priorities and allocating resources in health regions: lessons from a project evaluating program budgeting and marginal analysis PMBA. Social Science and Medicine. Mullen PM: Public involvement in health care priority setting: are the methods appropriate and valid?.

In The global challenge of health care rationing. Book Google Scholar. Daniels N: Four unsolved rationing problems: a challenge. Klein R, William A: Setting priorities: what is holding us back — inadequate information or inadequate institutions?. Ham C: Tragic choices in health care: lessons from the Child B case.

Mitton C, Donaldson C: Health care priority setting: principles, practice and challenge. Cost Effectiveness and Resource Allocation. Norheim O: Procedures for priority setting and mechanisms of appeal in the Norwegian health care system. Martin D, Singer P: A strategy to improve priority setting in health care institutions. World Journal of Surgery.

Download references. We would like to acknowledge gratefully the senior leadership at the Saskatoon Health Region, the Kingston General Hospital and the Ottawa Hospital who participated in the workshops and who have given us permission to share lessons learned from their workshops. Grant support: The views expressed herein are those of the authors and do not necessarily reflect those of the supporting groups.

Gibson was supported by a Canadian Health Services Research Foundation post-doctoral fellowship while writing this paper. You can also search for this author in PubMed Google Scholar.

Correspondence to Jennifer L Gibson. The authors were compensated by the health care organizations for facilitating the priority setting workshops and continue to consult with these and other health care organizations. JLG conducted the workshops on which this paper is based, collated and analysed the data, and drafted the manuscript. PAS conducted the workshops on which this paper is based, participated in analysing the data, commented on earlier drafts of the manuscript, and conceived of the paper.

Reprints and Permissions. Gibson, J. Setting priorities in health care organizations: criteria, processes, and parameters of success. Download citation. Received : 11 February Accepted : 08 September Published : 08 September Anyone you share the following link with will be able to read this content:.

Sorry, a shareable link is not currently available for this article. Provided by the Springer Nature SharedIt content-sharing initiative. Skip to main content. Search all BMC articles Search. Download PDF. Abstract Background Hospitals and regional health authorities must set priorities in the face of resource constraints.

Discussion We facilitated workshops for board members and senior leadership at three health care organizations to assist them in developing a strategy for fair priority setting. Summary Lessons learned in three workshops fill an important gap in the literature about what criteria, processes, and parameters of success Board members and senior managers would use to set priorities fairly.

Background Hospitals and regional health authorities in Canada and elsewhere are facing significant resource allocation challenges. Table 1 Accountability for reasonableness 16 Full size table.

Discussion Presentation of lessons learned Priority setting criteria When decision-makers were asked what criteria they would use to set clinical service priorities, we found that responses clustered around eight 8 criteria Table 2. Table 2 Priority setting criteria Full size table.

Projects prioritising healthcare change alison baxter

Epicor software support phone number	Thus, decision-makers in other health care organisations may draw lessons from these workshops to operationalise fair priority peojects processes that reflect the particularities of their institutional more info and ensure accountability for the reasonableness of their clinical service priorities. List and review each opportunity with your team. Public Health England. Each of these attributes are examples of prioritization criteria. You can use whatever categories seem to make the most sense for your group. Discussion is needed to make final selections.
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Prioritising change projects healthcare	Rob highmark any duplicates from the list. It affects only a few people in a couple of meetings and can be implemented in just porjects few weeks. Some people talk about having too many projects, others worry about having too few resources. Peer Review reports. Survey clinicians, experts, and patients for candidate topics. Over time, as healthcare delivery has evolved, the complexity of achieving that mission and vision has increased.
Baxter theater movie times	Https://info.informaticknowledge.com/fratellis-baxter-village/11972-amerigroup-physicians.php at the Health Department. All authors read and approved the final manuscript. Browse Topics. We also excluded papers describing individual prioritization items or criteria. It is where the entire success of your portfolio begins. Here are some more resources healthcard criteria: A quick infograph that highlights top 4 signs your project prioritization criteria just won't work. Revenue Cycle Management.
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Carefirst new plymouth doctors	Health Information Exchange. Additional work with clinical teams can determine the root cause of the variations. What is a Value Case? We've learned a thing or this web page over the years and this page is where we share that learning with you. There are other, more advanced optimization algorithms that will let you take into account not only budget, but also multiple other constraints
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Explore our resource center to find templates to help you get the job done, job interview tips, insights to tackle your biggest project management challenges, and so much more. It pays to be certified in project management. We can help you meet that requirement. How successful could you be if you were more productive? Master widely-used productivity tools like Trello, Todoist, and Google Drive to optimize your workflow and spend time doing the work that truly matters.

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Project Management. Michelle Symonds. It takes a certain amount of skill and expertise to manage a complex project. A project manager has to juggle the inherent risks, interdependent tasks, constraints , allocation of resources, budgets and schedules that come with all projects whatever their size or complexity. So how do you decide which tasks to prioritize to get the best outcomes from your projects?

Take your project management skills to the next level with our comprehensive and free ebook! To manage a single complex project, using a systematic process that follows best practices that have developed in the industry over several decades saves you time and effort. Why reinvent the wheel when you can take the best that others have learned, and apply it to your projects?

Experienced project managers will often have developed the skills and expertise required to prioritize projects through both on-the-job experience, formal training, and study for project management qualifications like APM, PMP , or PRINCE2. But rarely in business is there just one project occurring at any given time. There are more likely to be several projects on the go, and a portfolio manager or program manager will have overall responsibility of a number of projects all competing for attention and, consequently, requiring an effective project prioritization process.

This can be taxing even for experienced project managers to handle without an effective method in place. Before we look at the different ways of prioritizing projects let's look at the difference between portfolio and program management.

These are two areas closely related to project management but with their responsibilities and issues and requiring a distinct set of project management skills. Program management is merely the process of project managing a group of projects at the same time. This is usually because they are related to each other and are all required as part of a broader strategic aim within an organization. One of the main advantages of managing projects as part of a program of changes is to avoid teams working in silos and potentially ending up with final deliverables that don't work well together.

It is also useful for ensuring adequate resources are applied where necessary, and those skill sets are shared across projects. Where a project manager has responsibility for a single project, and a program manager has responsibility for a group of related projects, a portfolio manager, on the other hand, has the even greater responsibility to oversee a much broader group of projects and programs; the aim being to implement broader business objectives.

A portfolio manager is responsible for budgets, resources, and schedules across a much wider section of a business or even across the entire enterprise.

They tend to be accountable for projects in a variety of different areas of the business. For that reason, portfolio management is much more focused on strategy and vision and, hence, future projects that might be required to deliver long term objectives. Portfolio managers, therefore, are responsible for determining the relative priority of individual projects across an organization.

And, of course, the need for a systematic process to prioritize these projects. It's reasonably obvious that projects need to be prioritized because we cannot do everything — or not all at the same time. Budget, talent, or both constrain most organizations. So a methodical process is required to determine what projects can be done to deliver the most value, given budget and resource constraints. There is a wide range of techniques that can help with this prioritization and they will typically cover:.

This is a well-known technique for determining what is necessary to stakeholders. It is quick and simple to use but is limited in its ability to accurately categorize stakeholder requirements. For that reason, it is best suited to less complex projects. MoSCoW is an acronym with o's added to make it easier for us to remember of the following stakeholder requirements:.

The Kano model is based on the assumption that end-user satisfaction with the final deliverable of a project is related to the features and functions available. The level of satisfaction is usually determined through a standard questionnaire. The model breaks the elements down into four separate categories:. Many components of health IT can factor into improvement opportunities and potentially accelerate strategies. However, while considering opportunities and developing strategy, organizations should remain focused on activities that will yield the highest value, through such benefits as improved patient care and clinician work satisfaction.

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