PHLT 8450 Week 7 Priority Setting Memo Example

Memorandum

To: Resident Steering Group and Clinic Assessment Team

From: Assessment Coordinator (PhD in Public Health student)

Date: Month Day, Year

Re: Priority ranking for the community health assessment, with the method, the scores and the rules that governed them

Purpose

This memo records how the resident steering group ranked the health problems raised during the assessment and why the result can be trusted. Under the participation plan, the ranking method is a decision the steering group holds outright. The memo therefore sets out the sequence first: the method was chosen and voted on at the group's third meeting, the scoring rules were written down and signed that evening, and the data book with the community profile and listening session results was distributed only at the fourth meeting. Nothing in the data could have shaped the choice of method, because no member had seen it.

Why the Hanlon Method

The clinic team presented three options: a simple dot vote, a criteria matrix the group would design itself and the Hanlon method, also called the basic priority rating system (Hanlon & Pickett, 1984). The group chose Hanlon for two reasons members stated during the vote. It makes each judgment visible, so a resident who disagrees with a rank can point to the score that produced it. And it separates how many people a problem touches from how badly it harms them, which members felt the last hospital-led assessment had blurred by ranking whatever appeared most often in its mailed survey. Pennel et al. (2015) found that nonprofit hospital assessments frequently describe their prioritization process only vaguely, and the group wanted a method whose arithmetic anyone could rerun.

How Each Problem Was Scored

Hanlon rates each problem on three components. Size, scored 0 to 10, reflects the share of the community affected. Seriousness, scored 0 to 20, combines urgency, severity, economic loss and the burden on others, and counts double in the formula. Effectiveness, scored 0 to 10, reflects how well available interventions work. The priority score is (size + 2 × seriousness) × effectiveness.

The group adapted the method in one way and recorded the adaptation before scoring. Seriousness was scored by the nine steering group members independently, on paper, and the average was used; clinic staff did not score it. Size was scored by the clinic team from the data book, using a conversion table the group approved in advance, and effectiveness was scored by the clinic team from published evidence summaries, with each score and its source read aloud and open to challenge.

The Scores

Two results surprised the clinic team. Drinking water ranked second despite a lower effectiveness score than the clinical problems, because residents rated its seriousness the highest of any problem: households that haul water describe the cost, the lifting and the worry about what children drink as daily burdens. Road flooding ranked above coverage because it affects the most people, including families whose children miss school when buses cannot pass, a pattern the school records in the profile had already shown.

Table 1

Hanlon Scores for Eight Problems (Composite Figures)

Note. Composite figures. Seriousness is the mean of nine members' independent ratings, rounded to the nearest whole number.

Feasibility Screened Afterward

After scoring, the group applied the PEARL test, which asks of each top-ranked problem whether action is proper, economically sensible, acceptable to the community, resourced and legal (Hanlon & Pickett, 1984). Under the rules signed beforehand, a problem fails PEARL only if a member can name the specific barrier, and a "no" on resources does not remove a problem when another public body controls the resources needed. That rule mattered for water and flooding. The clinic cannot repair a water line or regrade a road, but the county and the water utility can, so both problems stayed on the list as advocacy priorities rather than service priorities. No problem in the top five failed the test.

Rules Written Before Results

The rules adopted at the third meeting, and applied without change, were these:

Ties

A tie in priority score would be broken by a show of hands among steering group members, not by the clinic team. No tie occurred.

Rescoring

Any member could ask for a component to be rescored by giving a reason in writing. One member asked for the size of the septic problem to be reconsidered because county permit records undercount failed systems; the clinic team agreed the records were incomplete but kept the score, and the request and answer are attached.

Cutoff

The top three problems go forward to the capacity analysis, with the fourth held in reserve if a top-three problem proves to have no realistic path to action.

Public record

All scores, the conversion table and the signed rules will appear in the final report so residents outside the group can check the arithmetic.

Limits

The method's numbers look precise, but each is a judgment. Seriousness reflects nine people's views, and a different nine might rate differently, although members were chosen so that every colonia had a voice (Israel et al., 1998). Effectiveness scores lean on studies conducted mostly in clinical settings, which may favor clinical problems over infrastructure. The memo reports these limits so the ranking is treated as a structured decision by the people entitled to make it, not as a measurement.

Next Step

The capacity analysis due next week will take the three top-ranked problems, diabetes control, drinking water and road flooding, and examine what the community, the clinic and outside bodies can each contribute.

References

Hanlon, J. J., & Pickett, G. E. (1984). Public health administration and practice (8th ed.). Times Mirror/Mosby College Publishing.

Israel, B. A., Schulz, A. J., Parker, E. A., & Becker, A. B. (1998). Review of community-based research: Assessing partnership approaches to improve public health. Annual Review of Public Health, 19, 173-202. https://doi.org/10.1146/annurev.publhealth.19.1.173

Pennel, C. L., McLeroy, K. R., Burdine, J. N., & Matarrita-Cascante, D. (2015). Nonprofit hospitals' approach to community health needs assessment. American Journal of Public Health, 105(3), e103-e113. https://doi.org/10.2105/AJPH.2014.302286