Determine the Purpose of Ranking |
| The first step in designing a ranking process that is tailored to the community is deciding what the team hopes to achieve through the process and how the results will be used. Two questions to consider are: (1) What outcomes are expected from the process? and (2) How will the results of the ranking be used? |
| If the desired outcome is to build community support, then the assessment team might choose to use a tool that emphasizes community values over technical information. One way to do this is to calculate additional weight for criteria that the community has identified as especially important, such as impact on children. Other purposes might include educating the public, changing departmental priorities, and cataloguing technical information for a range of future uses. This decision has implications for who should be engaged in the process, what information should be considered, and how the information should be packaged and presented. |
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Decide on Ranking Criteria |
| Although individual judgment plays a role in the ranking process, the use of clear and agreed-upon criteria will ensure that the participants view the process as fair and valid. The process can be facilitated by use of a worksheet that standardizes the criteria, summarizes the team’s knowledge and attitudes about a given issue, and alerts members to additional data needs. The information to complete the worksheet is derived from the corresponding issue profile developed in Task 9. |
| Use the sample worksheet [Environmental Health Issue worksheet] as a starting point in the discussion of criteria. In the sample worksheet, each environmental health issue is characterized according to magnitude of risk, distribution of risk in the community, and severity of risk. Discuss these criteria. Do they make sense for the community being assessed? Will they help in the ranking process? Are there other criteria that would help in discriminating among the issues? The set of criteria chosen by the team may be similar to those on the sample worksheet or completely different. What matters is that the participants agree on a set of criteria and consider these criteria as they evaluate each issue. |
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Select a Method for Ranking |
| After deciding on the criteria, adapt/revise the sample worksheet, or design another. Fill out the worksheets as a group or individually, using information from the issue profiles created in Task 9. Develop a composite of individual scores through discussion and consensus building and/or use of group decision-making techniques. |
| If team members work on this task independently and then wish to generate a group score, the results can be added (or averaged). Participants can also vote to reach group consensus. If there is discrepancy in individual evaluations, the team would listen to the arguments of those in support of each option and then vote for the more compelling “answer.” Unresolved debate or controversy may indicate a need to collect more information. |
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| At the end of the worksheet, participants are asked to summarize the importance of the issue (high, medium, or low concern). This step involves judgment and is therefore an expression of personal values. When translated into concrete and explicit criteria, these expressions of values provide fertile ground for developing mutually acceptable plans and defining a community’s priorities. This step therefore forms the foundation for the priority-setting task presented next. A potential pitfall at this point is assuming that all participants understand the professional judgments and public health “value” systems used to rank environmental health issues. Explicit articulation of these values will facilitate the process and minimize frustration, confusion, and nonproductive debate. |
| Participants should continually ask themselves: Why did I score this risk as I did? For example, is the risk of environmental lead exposure scored “high” because: |
- The risk is unfairly distributed according to race?
- It affects the development of children rather than adults?
- It affects lower income persons who may not be able to choose lead-safe housing and thus may be more exposed to a health risk?
- It is particularly dangerous to pregnant women and their babies?
- All of the above?
Participants may not base their decisions on similar reasons or values. The underlying value systems on which health policies are based are generally unstated. By explicitly stating reasons for their rankings, participants at least can have a common basis for discussing values and policies and an opportunity to gain consensus on community health actions. |
| Whether summarized quantitatively or qualitatively, the final scores will allow the issues to be ranked relative to one another, with regard to the agreed-upon criteria. Issues found to be of “high concern” (or meeting some other agreed-upon cutoff point) will be evaluated in terms of overall community priorities in Task 11. |
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The Value of Local Process |
| Although the tools included in PACE EH have been found to be useful and most PACE EH communities did not alter them significantly, many coordinators reported that their teams needed to put aside the supplied tools and think through locally appropriate ranking and prioritizing processes. |
| Ranking and prioritizing are complex and difficult processes, made more so because they require assessment team members to examine their own values, opinions, and judgments. Thus, teams must understand the rationale behind any system for ranking and prioritizing the issues before participating in the exercise. Users of PACE EH may find the tools included here useful for beginning a discussion about their own ranking and prioritizing processes. This approach reflects the philosophical intent of the authors: users are encouraged to adopt included tools where helpful, alter them where necessary, or jettison them altogether if the team advocates a more locally appropriate approach. |
Question to consider:
Can you describe “ranking” in regards to a PACE EH process? |
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