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

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

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

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

6. A PRIORITY SETTING PROCESS: ADVANTAGES Utilizes available injury data Utilizes available injury data Incorporates qualitative and quantitative considerations Incorporates qualitative and quantitative considerations Provides structure to stakeholder deliberations Provides structure to stakeholder deliberations Is transparent, can be documented Is transparent, can be documented Can be revisited over time 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 Primary Data Collection Local Surveillance Surveys Deaths, Hospital Admissions, ER Visits PCRs, CCHS, AB Survey, CHMS, Incident Reports, In-house reporting systems Social Environment Personal Environment What meaning does my social network and society give to falls? What meaning do older people give to falls? 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)

10. 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) Knowledge Translation Program Development “Falls Among Older People”

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) 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) 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 Interest expressed recently by Safe Communities and others To be further refined by partners To be further refined by partners

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

15. PRIORITY SETTING PROCESS CAUSE CATEGORIES (eg-Wpg) 1.Violence 2.Suicide/self-inflicted 3.Falls 4.Motor vehicle 5.Poisoning 6.Drowning 7.Fire/Burn 8.Suffocation

16. PRIORITY SETTING PROCESS QUANTITATIVE CRITERIA 1.Number of deaths 2.Potential years of life lost 3.Number of hospitalizations 4.Average LOS (severity proxy) 5.Use other if available (e.g. ED data, cost etc)

17. QUANTITATIVE PROCESS: RANKING AND SCORING 1.Populate a spreadsheet with data 2.Rank with highest = 1 3.Sum all ranks (rank totals) 4.Rank the totals 5.Lowest score denotes highest overall quantitative priority

18. QUANTITATIVE CRITERIA Violence Suicide/ Self- inflicted Falls Motor Vehicle PoisonDrown Fire/ Burn Suffoca- tion 1.Deaths 13567539835496787078 1.PYLL (%) 10364194543 1.Hospitalizations 35853644244893625101158825273 1.Ave LOS 101333161242218 Rank sums Quantitative Priority Ranking STEP 1: Populate data

19. QUANTITATIVE CRITERIA Violence Suicide/ Self- inflicted Falls Motor Vehicle PoisonDrown Fire/ Burn Suffoca- tion 1.Deaths 135 4 675 1 398 2 354 3 96 5 78 6.5 70 8 78 6.5 1.PYLL (%) 10 3 36 1 4 2.5 19 2 4 2.5 5 4.5 5 4.5 3838 1.Hospitalizations 3585 4 3644 2 24489 1 3625 4 1011 5 58 8 825 6 273 7 1.Ave LOS 10 7 13 5 33 1 16 4 12 6 4848 22 2 18 3 Rank sums Quantitative Priority Ranking STEP 2: Rank the order

20. QUANTITATIVE CRITERIA Violence Suicide/ Self- inflicted Falls Motor Vehicle PoisonDrown Fire/ Burn Suffoca- tion 1.Deaths 135 4 675 1 398 2 354 3 96 5 78 6.5 70 8 78 6.5 1.PYLL (%) 10 3 36 1 4 6.5 19 2 4 6.5 5 4.5 5 4.5 3838 1.Hospitalizations 3585 4 3644 2 24489 1 3625 3 1011 5 58 8 825 6 273 7 1.Ave LOS 10 7 13 5 33 1 16 4 12 6 4848 22 2 18 3 Rank sums 18910.51222.52720.524.5 Quantitative Priority Ranking STEP 3: Sum all the ranks

21. QUANTITATIVE CRITERIA Violence Suicide/ Self- inflicted Falls Motor Vehicle PoisonDrown Fire/ Burn Suffoca- tion 1.Deaths 135 4 675 1 398 2 354 3 96 5 78 6.5 70 8 78 6.5 1.PYLL (%) 10 3 36 1 4 2.5 19 2 4 2.5 5 4.5 5 4.5 3838 1.Hospitalizations 3585 4 3644 2 24489 1 3625 4 1011 5 58 8 825 6 273 7 1.Ave LOS 10 7 13 5 33 1 16 4 12 6 4848 22 2 18 3 Rank sums 18910.51222.52720.524.5 Quantitative Priority Ranking 41236857 STEP 4: Rank the totals

22. QUALITATIVE PROCESS 1.Establish qualitative criteria by group consensus 2.Assign a score for each qualitative criterion for all causes (1-3 or 1-5) where highest = most agreement 3.Sum all scores (highest score wins) 4.Rank the totals 5.Lowest rank denotes highest overall quantitative priority

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

24. Qualitative criteria Viol.Suic.FallsMVPois.DrownBurnSuff 1. Disproportionate burden 2. Effective interventions12332332 3. Opportunity gap exists 4. Cost savings 5. Worsening Trends 6. Within your mandate 7. Ability to influence others 8. Lack of readiness-other sectors 9. Public readiness 10. Political readiness Sum Score Qualitative Priority Ranking

25. Qualitative criteria Viol.Suic.FallsMVPois.DrownBurnSuff 1. Disproportionate burden33333332 2. Effective interventions12332332 3. Opportunity gap exists12332232 4. Cost savings22332222 5. Worsening Trends22312112 6. Within your mandate33212111 7. Ability to influence others33333332 8. Lack of readiness-other sectors 13213112 9. Public readiness32222221 10. Political readiness21231112 Sum Score2223262321192018 Qualitative Priority Ranking

26. Qualitative criteria Viol.Suic.FallsMVPois.DrownBurnSuff 1. Disproportionate burden33333332 2. Effective interventions12332332 3. Opportunity gap exists22332232 4. Cost savings22332222 5. Worsening Trends22311112 6. Within your mandate33212111 7. Ability to influence others33333332 8. Lack of readiness-other sectors 13213112 9. Public readiness32222221 10. Political readiness21231112 Sum Score2223262321192018 Qualitative Priority Ranking 42125768

27. “BOTTOM LINE” ViolenceSuicideFalls Motor Vehicle PoisonDrown/ Suff. Fire/ Burn Suffocation QUANTITATIVE CRITERIA 41236857 QUALITATIVE CRITERIA 42125768 OVERALL XXX PUTTING IT ALL TOGETHER

28. PRIORITY SETTING PROCESS PUTTING IT ALL TOGETHER Making sense of the whole Making sense of the whole Establishing your “bottom line” Establishing your “bottom line” Examining priority populations 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 1.Brainstorm possible interventions for each priority issue (Haddon’s Matrix) 2.Establish effectiveness of potential actions identified 3.Explore feasibility/ cost of potential action 4.Identify relevant partners, connect 5.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