improvement in similar conditions or settings until systems changes have actually been implemented. Thus the committee turned to illuminating examples of systems transformation provided by workshop presenters and presented in the literature, and took into account the value of these experiences.

Recognizing that no priority-setting process is perfect, the committee believed it essential to make its process as transparent as possible, being clear and open about the bases for its decisions (Daniels, 2000; Daniels and Sabin, 1998). The committee also decided that the process it adopted would have to be dynamic, capable of evolving over time, and characterized by ongoing interaction among its various components. A feedback loop would be needed as well to allow for periodic revisiting and updating of the priority areas and continuous assessment of progress.

This chapter describes the process used by the committee to identify the priority areas in the brief period of time available for this study. Additionally, a revised process is recommended for the future determination of priority areas, based upon the committee’s experience with its initial process.

FIGURE 4–1 Process model used by the committee.

Process use by the Committee

The process used by the committee, summarized in Figure 4–1, consists of the following steps:

  1. Determine a framework for the priority areas.

  2. Identify candidate priority areas.

  3. Establish criteria for selecting the final priority areas.

  4. Categorize candidate areas within the framework.

  5. Apply criteria to screen the candidates.

  6. Identify priority areas; reassess and approve.

Although the process appears to be linear in fashion, it is much more dynamic than a succession of orderly steps. The decisions required in the first three steps, for example, are all closely interrelated.



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