Squaring the circle: a priority-setting method for evidence-based service development, reconciling research with multiple stakeholder views.
BACKGROUND
This study demonstrates a technique to aid the implementation of research findings through an example of improving services and self-management in longer-term depression. In common with other long-term conditions, policy in this field requires innovation to be undertaken in the context of a whole system of care, be cost-effective, evidence-based and to comply with national clinical guidelines. At the same time, successful service development must be acceptable to clinicians and service users and choices must be made within limited resources. This paper describes a novel way of resolving these competing requirements by reconciling different sources and types of evidence and systematically engaging multiple stakeholder views.


METHODS
The study combined results from mathematical modelling of the care pathway, research evidence on effective interventions and findings from qualitative research with service users in a series of workshops to define, refine and select candidate service improvements. A final consensus-generating workshop used structured discussion and anonymised electronic voting. This was followed by an email survey to all stakeholders, to achieve a pre-defined criterion of consensus for six suggestions for implementation.


RESULTS
An initial list of over 20 ideas was grouped into four main areas. At the final workshop, each idea was presented in person, visually and in writing to 40 people, who assigned themselves to one or more of five stakeholder groups: i) service users and carers, ii) clinicians, iii) managers, iv) commissioners and v) researchers. Many belonged to more than one group. After two rounds of voting, consensus was reached on seven ideas and one runner up. The survey then confirmed the top six ideas to be tested in practice.


CONCLUSIONS
The method recruited and retained people with diverse experience and views within a health community and took account of a full range of evidence. It enabled a diverse group of stakeholders to travel together in a direction that converged with the messages coming out of the research and successfully yielded priorities for service improvement that met competing requirements.
School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK. r.hutten@sheffield.ac.uk.
Rebecca
R
Hutten
School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK. g.d.parry@sheffield.ac.uk.
Glenys D
GD
Parry
School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK. thomas.ricketts@shsc.nhs.uk.|Sheffield Health and Social Care NHS Foundation Trust, St George's Community Health Centre, Winter Street, Sheffield, S3 7ND, UK. thomas.ricketts@shsc.nhs.uk.
Thomas
T
Ricketts
NIHR Collaboration for Leadership in Applied Health Research and Care for Yorkshire and the Humber (CLAHRC YH), 11 Broomfield Road, Sheffield, S10 2SE, UK. jo.cooke@sth.nhs.uk.
Jo
J
Cooke
D032921:Consensus; D003362:Cost-Benefit Analysis; D019317:Evidence-Based Medicine; D005260:Female; D006296:Health Services / Q000592:standards*; D006801:Humans; D008297:Male; D036301:Qualitative Research; D058996:Quality Improvement; D012108:Research Personnel; D012648:Self Care; D011795:Surveys and Questionnaires