Focus on What's Important
Once you’ve accounted for your community’s needs and resources, you will decide which problem(s) to tackle. Without focus, all issues seem equally important. Taking time to set priorities will ensure that you direct your community’s valuable and limited resources to the most important issues.
Focus your community’s efforts and resources on the most important issues to achieve the greatest impact on health.
Who to Involve
People from business, healthcare, public health, education, government officials, elected boards, advocacy groups, faith-based organizations, not-for-profits, foundations or other investors, and anyone who cares about or is affected by the many factors that influence health in your community.
As you engage in this step, keep in mind the population with the greatest health disparities in your community -- those who are most vulnerable and are experiencing the worst conditions for good health. Involving them throughout your health improvement process will ensure that their voices and needs are heard.
By design, your multi-sector team represents various perspectives from your community; while this makes your team stronger it can also make choosing a focus difficult. A skilled, neutral facilitator can help guide your team through a priority-setting process, ensuring all voices are heard and that opposite viewpoints don’t negatively affect the process.
Effective facilitators are objective, but that doesn’t mean they have to come from outside the organization or team. Instead, it means that for the purposes of the decision-making process, the facilitator will take a neutral stance and focus on the process.
As you’ve gathered your multi-sector team to work together, you’ve likely already been using many of the consensus-building and decision-making skills you’ll need to Focus on What’s Important. You may want to look at the tools and other guidance found in Work Together, Engage members effectively.
As your team prepares to set priorities, it may help members to review what you learned during your assessment. You can prepare a summary or overview to present to your team or have members review the materials you developed to share your assessment results with your community (e.g., community presentations, fact sheets, reports, local media stories).
Materials used to share assessment results with your community
As you begin your priority-setting process, it may be helpful to focus your team on a guiding question. Reviewing your vision and mission statement can provide a helpful starting point. Key words or values in these statements will help you create your guiding question. For example, are you striving for the quickest improvement in health, the greatest impact on health, the greatest improvement for vulnerable populations, or the most efficient use of resources? Frame your guiding question to reflect the most important elements of your vision and mission.
Your team’s vision and mission statements
Choosing priorities is challenging. It’s not uncommon to feel like everything is a priority, but it’s important to recognize that your resources are limited and selecting a few issues to focus on will help you successfully make changes in your community. We recommend focusing on no more than five issues, but the number of priorities you select will depend on your resources and ongoing efforts in your community. Matching the number of priorities with your team’s capacity to take action is most important. It is better to pick fewer priorities and succeed than to choose too many priorities and find you can’t be effective in any of them.
There are a variety of processes for selecting priorities, but before you dive into a process, it’s helpful to agree on a set of criteria by which you will judge potential issues. Criteria express the values, standards, and basic ideas your team will consider when making choices and deciding priorities. (1) Keep your guiding question handy as you think about criteria. You’ve gathered helpful information during your assessment. The criteria you select here will help you use the data to identify priorities. Following are some potential criteria to consider:
- Who is affected?
- How many people are affected?
- Are there groups that are affected more than others?
- Where are the greatest opportunities for improvement?
- How severe are the effects?
- Based on the County Health Rankings model, how much does this issue contribute to health outcomes?
- What are the consequences of not intervening?
- Are there strategies that have been shown to effectively address this issue?
- What does the community think? Do they support this issue?
- What do policymakers think? Do they support this issue?
- What assets and resources can partners bring to address this issue?
- How long will it take to reach an outcome?
- What are the potential negative impacts of addressing the problem?
- What has been tried before? What were the barriers and successes of those attempts?
The criteria you use to Focus on What’s Important may also be helpful to consider as you Choose Effective Policies & Programs and Act on What’s Important. The data you use to identify priorities can also be used to help you set policy or programs goals and leverage resources as you implement your strategies. The criteria you select here will also help you shape your evaluation plan.
It’s important to remember that no one priority-setting method is best all of the time. Your decision will depend on the size of the team you’re working with, the amount of time you have, and how much participation you want to ensure. A good priority setting process will clearly define:
- The criteria on which you will compare options
- Processes to vote/score/rank options
- Roles and processes to make the final choices (2)
MindTools.com’s The Role of a Facilitator suggests some factors and options to consider when deciding the process you will use to make group decisions.
- The number of participants. If you have a large group, you might consider using smaller “break-out” groups.
- The level of participation you want to ensure. If you’re concerned about participation, giving participants time in the agenda to think about and write down their thoughts may be a good strategy.
- The background and positions of the participants.
- How well participants know the subject and each other.
- The time you have available.
First Things First: Prioritizing Health Problems (from the National Association of County & City Health Officials [NACCHO]) describes five prioritization methods:
- Multi-voting Technique - typically used when a long list of health problems or issues must be narrowed down to a top few.
- Strategy Grids - provide a mechanism to take a thoughtful approach to achieving maximum results with limited resources.
- Nominal Group Technique - useful in the early phases of prioritization when there exists a need to generate a lot of ideas in a short amount of time and when input from multiple individuals must be taken into consideration.
- The Hanlon Method – use when the desired outcome is an objective list of health priorities based on baseline data and numerical values.
- Prioritization Matrix - when health problems are considered against a large number of criteria or when an agency is restricted to focusing on only one priority health issue.
Each sub-section includes step-by-step instructions on implementation, examples illustrating practical applications, and template worksheets you can use for each method.
In addition to a formal process, some communities will take their potential priority issues to the public for their input. There are a variety of ways to get input from the public such as holding community forums, making presentations to various community organizations, and conducting community surveys.
Start with your guiding question, and ask participants what they see as the top two or three issues based on that question and the data they’ve reviewed. Brainstorming is an effective and simple way to come up with ideas in a group.
Traditionally, brainstorming exercises start with a question or problem, and participants respond with whatever comes to mind. A recorder writes down the comments made on a large piece of paper or whiteboard, so everyone can see them. Alternatively, a couple of variations on traditional brainstorming are:
- Have participants brainstorm individually before the group activity. Each person generates his or her own ideas privately and later shares them with the group. You might give participants sticky pads to write down their ideas.
- Have participants review the data and consider the guiding question ahead of time and come prepared with their ideas of two to three issues on which to focus.(3)
Brainstorming: Generating Many Radical, Creative Ideas (from MindTools.com) describes why and how to use brainstorming to generate ideas. If you're still not getting the ideas you want, try using these approaches to increase the number of ideas that you generate:
- The Stepladder Technique improves the contribution of quieter members of the group, by introducing ideas one person at a time.
- The Crawford's Slip Approach helps you get plenty of ideas from all participants in your session, and gives you a view of the popularity of each idea.
- Charette Procedure helps you brainstorm effectively with large groups of people.
You can do this informally by using your criteria as a general guide and voting on the top issues or follow a more structured process of rating each potential priority issue. The tools listed below provide helpful examples of each approach to priority-setting and may be adapted to fit the process and criteria you’ve selected.
If your team is struggling to cull the list of potential priorities to a more manageable number, try ordering your options in different ways:
- Logical order — Present issues in the sequence in which they should be addressed. This is useful where the resolution of one issue is contingent on resolution of another.
- Impact order — How strategic is an issue? How important are its consequences? How complex is an issue? Resolving easier issues first can build the momentum, teamwork, and consensus that can lead to solutions for more complex, controversial issues.
- Temporal order — Resolve issues according to a timeline, using information such as coordination with upcoming events or a logical order for dealing with the issues. For example, an issue that seems to require a policy strategy may be timed to coincide with the state legislative cycle. (4)
If you are still having trouble narrowing down your list, consider doing a root cause analysis. Analyzing Root Causes of Problems: The “But Why?” Technique is a simple and effective process. However, for more complex issues, you may want to use the Affinity Diagram. This may help you identify the basic reasons behind a problem or issue you’re seeing in your community and highlight where you need to start to most effectively address the issues. You may also find that several of your potential focus areas have the same or similar root causes. Root Causes Analysis can be particularly useful for exploring social and economic factors such as employment issues or community safety. (5)
When decision criteria are subjective and it's critical that you gain consensus, you can use techniques like Nominal Group Technique and Multi-Voting to help a group agree on priorities. Be sure to allow enough time for full and open discussion after these voting procedures, so that the group doesn’t fall into Group Think, which occurs when the desire for group consensus overrides people's common sense desire to present alternatives, critique a position, or express an unpopular opinion.
As a team, review your resulting list of priorities. Does it make sense? Does it resonate with your multi-sector members? Will these priorities resonate with the community? If you haven’t sought public input, this is the opportunity to do so. Hold final decisions until you have evidence of community support for your chosen priorities. This is also a good time to review your priority-setting process.
To ensure that your team and community can successfully act on the priorities you’ve selected, it’s important to communicate your decisions with decision makers and those who influence them. (1)
Consider the following questions when deciding how to communicate your priorities.
- Who must understand and support your plans to address priority issues? Be as specific as possible.
- Who should tell them?
- What media or methods should be used to tell them? (e.g., stories, reports, news media).
- Visit the COMMUNICATE step of the Action Center to learn more about effective ways to communicate your priorities and work
Other County Health Rankings & Roadmaps resources
- Take Action: Focus on What’s Important webinar recording and slides. (July 10, 2012)
- Take Action: Focus on What’s Important In-depth slides and key take-aways handout. (July 23, 2012)
- Rockingham County, North Carolina establishes task force to identify the root causes of its poor health rankings, develops recommendations
- The Greater Flint Health Coalition in Genesee, Michigan uses a dashboard approach to communicate their County Health Rankings priority goals.
- Developing Facilitating Skills (from the Community Tool Box) provides an overview of what facilitation skills are and why they’re important. This section also covers three basic parts of facilitation: the process of the meeting, skills and tips for guiding the process, and preventing and dealing with disrupters.
- Defining and Analyzing the Problem (from the Community Tool Box) includes guidance to help communities define a problem and determine whether an identified problem is a priority.
- What Drives Health (from the Robert Wood Johnson Foundation) discusses how social factors like education, income, work, and housing can affect health directly and indirectly.
- Setting Priorities Webcast (audio & slides) one hour webcast from The Health Communications Unit (Public Health Ontario) that introduces participants to a selection of strategic, group-oriented, priority-setting techniques.
(1) Forest LB, McKenna C, Donovan J. Connections: A "How To" Handbook for Developing Extension Long-Range Plans and Major Problems. Madison, WI; 1986 April 1986.
(2) van Boxmeer N, Thesenvitz J. Priority Setting – Four Methods for Getting to What’s Important! In: Ontario Health Promotion E-Bulletin. Toronto, ON: Health Nexus and Public Health Ontario; 2010.
(3) KU Work Group for Community Health and Development. Chapter 14, Section 9, Tool #1 Brainstorming Techniques. In: The Community Tool Box. Lawrence, KS: University of Kansas; 2012.
(4) National Association of County & City Health Officials. Phase 4: Strategic Issues In-depth Guidance. In: Mobilizing Action through Planning and Partnerships (MAPP) Framework. Washington, DC: National Association of County & City Health Officials.
(5) KU Work Group for Community Health and Development. Chapter 17, Section 4: Analyzing Root Causes of Problems: The "But Why?" Technique. In: The Community Tool Box. Lawrence, KS: University of Kansas; 2012.