SETTING INJURY PRIORITIES SMARTRISK Learning Series March 29, 2007 Dr. Sande Harlos, MOH

1. SETTING INJURY PRIORITIES SMARTRISK Learning Series March 29, 2007 Dr. Sande Harlos, MOH Winnipeg Regional Health Authority

2. OUTLINE • Priority setting- the challenge • Describe an approach to establishing priorities • Priorization example Take Home: a process to establish injury priorities in your area of work

3. PRIORITY SETTING- WHY BOTHER?? • Limited resources: • time • funding • manpower • Biggest impact • Coordinate efforts of stakeholders

5. PRIORITY SETTING- BASED ON WHAT CRITERIA? • Common sense? • Data? (If so which?) • Opportunity gaps? • Personal interest? • Media attention? • Political agendas? • Advocacy or lobby groups?

6. A PRIORITY SETTING PROCESS: ADVANTAGES • Utilizes available injury data • Incorporates qualitative and quantitative considerations • Provides structure to stakeholder deliberations • Is transparent, can be documented • Can be revisited over time

7. The role of “Evidence” • Focus on “evidence-informed” or “evidence-based” planning, and knowledge translation…. EVIDENCE ACTION ? How????

8. Evidence Action • Not a simple process! • Take into consideration many types of available “evidence” describing a problem • Identify priority issues to address • Consider available interventions that work to address priority issues • Implement and take stock of what’s working (evaluation)

9. Quantitative Approach: Looking AT – “Falls Among Older People” Aggregate Data Base Analysis Deaths, Hospital Admissions, ER Visits • Primary Data Collection • Local Surveillance • Surveys PCRs, CCHS, AB Survey, CHMS, Incident Reports, In-house reporting systems Qualitative Approach: Looking IN – “Falls Among Older People” Social Environment What meaning does my social network and society give to falls? Personal Environment What meaning do older people give to falls? Source: Alberta Centre for Injury Control and Research Workshop March 2007 (based on “Undertaking Qualitative Research- Concepts and Cases in Injury, Health and Social Life” by J. Peter Rothe)

10. Knowledge Translation Program Development “Falls Among Older People” Quantitative Approach: Looking AT – “Falls Among Older People” Qualitative Approach: Looking IN – “Falls Among Older People” Source: Alberta Centre for Injury Control and Research Workshop March 2007 (based on “Undertaking Qualitative Research- Concepts and Cases in Injury, Health and Social Life” by J. Peter Rothe)

11. Evidence Action • Not a simple process! • Take into consideration many types of available “evidence” describing a problem • Identify priority issues to address • Consider available interventions that work to address priority issues • Implement and take stock of what’s working (evaluation)

12. Disclaimer!!! This is … • really really really simple • homemade • mostly a recipe for common sense Adapt, improve and enhance at will!

13. BACKGROUND: SAMPLE PRIORITY SETTING PROCESS • Arose from WRHA strategic planning process (2000), reused (2005) • Was adapted and used by the F/P/T Sub-committee on Injury Prevention and Control (2001) • Interest expressed recently by Safe Communities and others • To be further refined by partners

14. PRIORITY SETTING PROCESS OVERVIEW (“recipe”….) • Quantitative criteria (data) • Qualitative criteria (readiness, potential, capacity to effect change) • Ranking and scoring • Putting it all together • Sub-groups- priority populations? • Reality check

15. PRIORITY SETTING PROCESS CAUSE CATEGORIES (eg-Wpg) Violence Suicide/self-inflicted Falls Motor vehicle Poisoning Drowning Fire/Burn Suffocation

16. PRIORITY SETTING PROCESS QUANTITATIVE CRITERIA Number of deaths Potential years of life lost Number of hospitalizations Average LOS (severity proxy) Use other if available (e.g. ED data, cost etc)

17. QUANTITATIVE PROCESS: RANKING AND SCORING Populate a spreadsheet with data Rank with highest = 1 Sum all ranks (rank totals) Rank the totals Lowest score denotes highest overall quantitative priority

18. STEP 1: Populate data

19. STEP 2:Rank the order

20. STEP 3:Sum all the ranks

21. STEP 4:Rank the totals

22. QUALITATIVE PROCESS Establish qualitative criteria by group consensus Assign a score for each qualitative criterion for all causes (1-3 or 1-5) where highest = most agreement Sum all scores (highest score wins) Rank the totals Lowest rank denotes highest overall quantitative priority

23. PRIORITY SETTING PROCESS QUALITATIVE CRITERIA • Disproportionate burden • Effective interventions • Opportunity gap • Potential cost savings • Trends • Impact within mandate • Ability to influence others • Lack of readiness in other sectors • Readiness of public • Readiness of political systems

27. PUTTING IT ALL TOGETHER “BOTTOM LINE”

28. PRIORITY SETTING PROCESS PUTTING IT ALL TOGETHER • Making sense of the whole • Establishing your “bottom line” • Examining priority populations

29. PRIORITY SETTING PROCESS PRIORITY POPULATIONS Examples from F/P/T subcommittee: Priority: FALLS • Falls in older adults • Falls in older children • Priority: SUICIDE • Suicide in young people • Suicide in Aboriginal people

30. REALITY CHECK Do the priorities make sense? Are there any barriers to action that have been overlooked? Does the outcome fit with general priorities/directions?

31. NOW WHAT? Priority issues have been identified NOW- developing plans to address each issue begins! We have existing tools: EG: Haddon’s Matrix

32. Overall planning process Brainstorm possible interventions for each priority issue (Haddon’s Matrix) Establish effectiveness of potential actions identified Explore feasibility/ cost of potential action Identify relevant partners, connect Plan details, implement, evaluate

33. SUMMARY • Sample approach to priority setting has been presented • Organizations, Communities can adapt the process to their planning needs • Utilizes available injury data • Considers important qualitative factors • Involves a consensus building process • Identifying priority issues is the first step in developing a plan

34. QUESTIONS AND DISCUSSION