Using staff input to set priorities in an Indian Health Service clinic

The McLaughlin Public Health Service clinic serves several thousand Lakota people (Sioux) on Standing Rock Indian Reservation, SD. In 1981, a priority-setting exercise established for the first time a grassroots expression of the concerns of the clinic's staff. A three-step process was used in which each staff member first compiled an open-ended list of health needs, then ranked the relative contribution of five factors to making these problems important, and assessed each problem listed by those factors. The factors used were mortality, morbidity, vulnerability to intervention, facilities on hand, and social implications. The resulting priority table represented each person's assessment of the health needs of the community. A composite table was created to represent the group's assessment. The staff concluded that among the many problems listed, alcoholism and diabetes were the most compelling health problems. The priority score was almost identical for each, but the reasons were different. Alcoholism was rated highly because it was felt to be widespread and had serious social implications. Diabetes was ranked highly because it was felt to be lethal and vulnerable to intervention. A significant long-term benefit to the clinic of the 3-month process was to stimulate consultation within the local clinic and to unify the health team, endowing the members with a common sense of purpose.