Prioritization Tools

Group methods for narrowing down and ranking a list of improvement ideas include voting and prioritization matrices. Both methods allow individuals to express their opinions or choices in reaching a group decision. Voting is a relatively unstructured technique where group members make a choice, using either implicit or explicit criteria. A prioritization matrix allows the improvement team to review the options against a set of explicit criteria.

 

Voting

 

When to Use Voting

Voting is most useful when the improvement options are fairly straightforward or time is limited. It encourages equal participation of all team members by equalizing decision making between dominant and quiet participants.

Improvement teams can structure voting in several ways.. Straight voting is the simplest, where each participant has one vote.  Multivoting allows participants to vote more than once and is useful when the group wants to pick more than one item to improve or when the list of items is very long and needs to be reduced to two or more. (To reduce a list to one item, use straight voting.)

Multivoting can be repeated several times until the list is short enough to work with or a single priority stands out. This voting method increases the likelihood that everyone will have at least one of the items for which they voted on the reduced list.

Weighting can be added to multivoting to allow participants to indicate the strength of their preference by allotting more votes to the same option. Weighted voting allows a group to select options on the basis not only of how important each is to the group but also how strongly the group feels about their options. Weighted voting is helpful when team members hold strong but divergent ideas about how to proceed.

Regardless of the type of voting used, all group members should understand the various options being voted on before voting begins.  

How to Use Straight Voting

 

 List all options and give each person in the group one vote.  (All votes are weighted equally.) The option with the highest total is selected.

Example of Straight Voting with 10 Participants

Option

Vote

Total

Option 1

X X X

3

Option 2

X X X X X

5

Option 3

X

1

Option 4

X

1

Total votes

 

10

How to Use Multivoting

List all options and allow each person to vote for a limited number of items (e.g., two to five). A general rule to determine the number of votes is:

  • Up to 10 options = 2 votes
  • 10–20 options = 3 votes
  • 20–30 options = 5 votes

Add up the votes for each item; the one with the highest score is the group’s top priority.

Example of Multivoting with 10 Participants, Three Votes Each

Option

Vote

Total

Option 1

X

1

Option 2

X X X X X X

6

Option 3

X X X X X X

6

Option 4

X X X X X X X X

8

Option 5

X X X

3

Option 6

X X X X

4

Option 7

 

 

Option 8

 

 

Option 9

X X

2

Option 10

 

 

 

 

30

 How to Use Weighted Voting

 List all options. Give each person a way to give more weight to some choices than to others. For example, give participants a fixed amount of hypothetical money, allowing each person to distribute it any way he or she wishes among the alternatives. If given $10, one could spend all $10 on a single item that he/she felt very strongly about, or he/she could distribute it evenly over five items, or any other combination. This method allows the voting to reflect each individual’s conviction about the various choices.

Another way to organize weighted voting is to list all the options on the wall or a flip chart and give each participant an identical number of colored stickers or dots.  Each sticker represents one vote.  Ask the participants to allocate their stickers among the options according to their preferences.  Count up the number of stickers placed by each option to determine the final votes.

Example of Weighted Voting with 10 Participants

 

Option

Team Member

Total

1

2

3

4

5

6

7

8

9

10

1

 

 

 

 

 

 

 

 

 

 

0

2

3

2

2

2

2

2

3

3

3

1

23

3

3

2

 

3

2

3

2

2

2

2

21

4

2

3

8

3

1

2

3

2

2

3

29

5

 

 

 

 

 

 

 

 

1

2

3

6

2

1

 

1

2

1

1

2

1

 

11

7

 

2

 

1

 

1

1

1

1

1

8

8

 

 

 

 

3

1

 

 

 

1

5

9

 

 

 

 

 

 

 

 

 

 

0

10

 

 

 

 

 

 

 

 

 

 

0

Points to Remember

While equal participation in the process can contribute to the group spirit, a minority may feel disenfranchised by the result. That is, they may feel that they lost out. This can diminish the coherency of the group dynamics. To prevent this, engage in team-building exercises after voting activities.

Prioritization Matrix

In each of the above voting options, each individual uses his or her own internal, unstated criteria to make a decision. A criterion is a measure, guideline, principle, or other basis for making a decision. Examples of criteria that are often used in health care settings are that activities must be affordable and safe. In teams, agreeing upon explicit decision-making criteria is a structured way of making a group decision.

Often in making decisions, people consider more than one criterion at the same time.  For group decision making, it can be helpful for the group to discuss and agree upon the criteria by which each participant should base his or her vote or selection. A multiple criteria or prioritization matrix is a tool for evaluating options based on a set of explicit criteria the group has determined is important for making an appropriate, acceptable decision.

Criteria can be weighted and ranked to help in the decision-making process. Although the prioritization matrix is the method most likely to result in consensus, at times it can be time-consuming and complex.

When to Use a Prioritization Matrix

Matrices work best when options are more complex or when multiple criteria should be considered in determining priorities or making a decision. The matrix presented below displays the options to be prioritized in the rows (horizontal) and the criteria for making the decision in the columns (vertical). Each option is then rated according to the various criteria.

Example of a Prioritization Matrix with Three Options and Four Criteria

Options

Criteria

Total

#1

#2

#3

#4

 

Option 1

 

 

 

 

 

Option 2

 

 

 

 

 

Option 3

 

 

 

 

 

How to Use a Prioritization Matrix

Step 1: List the options or choices to be evaluated. Make sure that all team members understand what each option means.

Step 2: Set the criteria for making the decision. The group can choose these criteria using brainstorming and then voting to determine the most important/relevant ones. Be sure that everyone understands what the chosen criteria mean.

Criteria commonly used for choosing problems to work on include importance, support for change, visibility of problem, risks if nothing is done, and feasibility of making changes in this area. For choosing solutions, the following criteria are often applied: cost, potential resistance, feasibility, management support, community support, efficiency, timeliness, and impact on other activities. These are not the only possible criteria; the group should develop a list that is appropriate for its situation.

No minimum or maximum number of criteria exists, but three or four is optimal to keep the matrix manageable. One way to reduce the number of criteria is to determine if there are any criteria that all options must meet. Use this criterion first to eliminate some options. Then, list the other criteria to prioritize the remaining options.

Another way to make the matrix less cumbersome is to limit the number of options being considered. If the list of options is long (greater than six items), it may be easier to first shorten the list by eliminating some options.

Step 3: Draw the matrix and fill in the options and criteria.

Step 4: Determine the scale to use in rating the options against each criterion. Ways to rate options range from simple to complex. A simple rating scale sets a score based on whether the option meets a given criterion, e.g., Are trained staff already available? The answer (vote) “yes” would gain one point, while “no” would gain zero points.

Another common rating scale scores options according to how well one option meets the criterion, e.g., How much management support is there for this option? The answer of “high” would garner three points, “medium” two points, and “low” one point (see note in box for another example).

A complex rating scale assigns a different maximum score (weight) to each of the criteria, and each option is scored independently on each criterion, up to the maximum weight of that criterion.

Example of Complex Rating Scale

Criteria

Maximum Points

Option 1

Option 2

Option 3

Client acceptability

50

25

35

50

Feasibility

35

30

20

28

Low cost

15

5

15

12

Overall rating

100

60

70

80

Step 5: Taking one option at a time, review each criterion and determine the appropriate rating, using the simple, common, or complex rating scale. This ranking can be done individually and then added up. Or, if the rating method is simple, it can be done by group discussion.

Step 6: Total the value for each option by adding the ranking for each criterion.

Step 7: Evaluate the results by considering the following questions:

  • Does one option clearly meet all criteria?
  • Can any options be eliminated?
  • If an option meets some but not all criteria, is it still worth considering?

Points to Remember

Make sure that everyone clearly understands the options under consideration and the definitions of the criteria.

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