Use 1000minds’ processes for creating tools to prioritize patients for access to health care.

The summary below is more fully explained and illustrated in:

P Hansen, A Hendry, R Naden, F Ombler & R Stewart (2012), “A new process for creating points systems for prioritizing patients for elective health services”, Clinical Governance: An International Journal 17, 200-9

The three 1000minds surveys referred to below support the following processes. They can be adapted (including pared down, if necessary) as participants work together to build a consensus prioritization tool.

Demonstrate need
Collate a dozen patient vignettes and run a Ranking Survey to capture individual clinicians’ intuitive rankings. Show them how inconsistent they are!
Elicit criteria
Run the same Ranking Survey but this time by consensus. As the group discusses who should be treated next, mind-map the criteria raised on a whiteboard.
Refine the criteria
Refine the criteria and levels based on the literature and available evidence.
Inter-rater reliability
Run a Categorization Survey for the clinicians to rate the dozen vignettes on the criteria. Show them how consistent they are.
Consensus rating
Repeat the Categorization Survey by consensus. Refine the text of the criteria and levels to improve shared understanding of the text. Draft supporting notes.
Individual judgements
Run a Preferences Survey for clinicians to experience making trade-offs between hypothetical patients rated on the criteria. Show them areas of agreement and disagreement.
Consensus weighting
Run a 1000minds decision-making exercise to weight the criteria and levels by consensus.
Validate results
Compare the ranking of the patient vignettes resulting from the group exercises with the initial consensus ranking. Perform other reliability tests.
Implement & socialise
Implement the prioritization tool in clinician information systems or prioritization web service (e.g. see NZ’s Ministry of Health) and socialise the new tool with clinicians who will it.