Alberta Health Services, Calgary, AB, Canada.
Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
Health Expect. 2017 Dec;20(6):1367-1374. doi: 10.1111/hex.12576. Epub 2017 May 31.
Providers have traditionally established priorities for quality improvement; however, patients and their family members have recently become involved in priority setting. Little is known about how to reconcile priorities of different stakeholder groups into a single prioritized list that is actionable for organizations.
To describe the decision-making process for establishing consensus used by a diverse panel of stakeholders to reconcile two sets of quality improvement priorities (provider/decision maker priorities n=9; patient/family priorities n=19) into a single prioritized list.
We employed a modified Delphi process with a diverse group of panellists to reconcile priorities for improving care of critically ill patients in the intensive care unit (ICU). Proceedings were audio-recorded, transcribed and analysed using qualitative content analysis to explore the decision-making process for establishing consensus.
Nine panellists including three providers, three decision makers and three family members of previously critically ill patients.
Panellists rated and revised 28 priorities over three rounds of review and reached consensus on the "Top 5" priorities for quality improvement: transition of patient care from ICU to hospital ward; family presence and effective communication; delirium screening and management; early mobilization; and transition of patient care between ICU providers. Four themes were identified as important for establishing consensus: storytelling (sharing personal experiences), amalgamating priorities (negotiating priority scope), considering evaluation criteria and having a priority champion.
Our study demonstrates the feasibility of incorporating families of patients into a multistakeholder prioritization exercise. The approach described can be used to guide consensus building and reconcile priorities of diverse stakeholder groups.
提供者传统上制定了质量改进的优先级；然而，患者及其家属最近也参与了优先级的制定。对于如何将不同利益相关者群体的优先级协调到一个可操作的组织优先列表中，知之甚少。
描述一个多元化利益相关者小组在建立共识方面使用的决策过程，该小组旨在协调两组质量改进优先级（提供者/决策者优先级 n=9；患者/家庭优先级 n=19），以形成一个单一的优先排序清单。
我们采用了一种改良的德尔菲法，让一个多元化的小组委员会来协调改善重症监护病房（ICU）中危重病患者护理的优先级。会议内容被录音、转录并进行了定性内容分析，以探讨建立共识的决策过程。
9 名小组成员，包括 3 名提供者、3 名决策者和 3 名以前危重病患者的家属。
小组成员在三轮评审中对 28 项优先级进行了评分和修订，并就质量改进的“前 5 项”优先级达成共识：从 ICU 到医院病房的患者护理过渡；家属的存在和有效沟通；谵妄筛查和管理；早期动员；以及 ICU 提供者之间的患者护理过渡。确定了四个对建立共识很重要的主题：讲故事（分享个人经历）、整合优先级（协商优先级范围）、考虑评估标准和有一个优先级支持者。
我们的研究表明，将患者家属纳入多方利益相关者的优先级制定工作是可行的。所描述的方法可用于指导共识的建立和协调不同利益相关者群体的优先级。
