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Introducing a modified nominal group technique for issue identification
Introducing a Modified Nominal Group Technique for Issue Identification Lois J. Pokorny Kenneth Lyle Margaret Tyler James Topolski Missouri Department oj Mental Health
The August 1987 issue of Evaluation Practice described the use of the Nominal Group Technique (NGT) in formative evaluations (Lapine, 1987). This article prompted us to share a modification of the NGT that we devised. The modified NGT served as a basis of a needs assessment using key informants. Lapine wisely urged compliance with the detailed structure of the NGT to ensure a positive outcome. We, the planning staff at the Missouri Department of Mental Health, were mindful that the benefits of the NGT would be diminished if the essential elements were disregarded. However, we felt that an additional component would improve its applicability to our planning task without sacrificing the strengths of the process. Our planning task was a complex needs assessment that we felt required that the group members have not only firsthand knowledge of the planning region, but also acquaintance with data and other pertinent materials. The modification enabled us to present these materials to the group members (our key informants) during the NGT process.
THE NOMINAL GROUP TECHNIQUE AND MODIFICATION The NGT offers a carefully structured process for conducting a group session (Delbecq et al., 1975). It is designed to provide all members of 40
41
the group equal opportunity for participation and to ensure equal consideration of all input. The NGT process begins with the presentation of a question to the group. The first phase of the NGT creates an arena for the generation of answers in response to the question. Each answer receives immediate acceptance; thus ideas are expressed that otherwise might be suppressed. An idea is not scrutinized until the second phase, when all ideas are displayed before the group members and individual ideas are seen in the context of all ideas. As a result, merit might be found in an idea that earlier would have been discounted, or an additional idea might emerge from a combination of ideas. Finally, all members receive equal vote on the rating of the importance of the finalized list of ideas. The product of the NGT is therefore likely to be better than the contribution of any individual member of the group. We modified the NGT by introducing new information to members during Phase 1, Issue Generation. Information sheets were prepared in advance of the meeting. Each information sheet provided material that might suggest ideas concerning the question posed . The information sheets were distributed one at a time to group members. The members reviewed an information sheet and silently wrote down the ideas suggested to them by this information. The group facilitator then proceeded to solicit participation from .group members and to record each idea. A "round-robin" order of participation was used in which all members were sequentially queried for ideas. After the members had exhausted their ideas based on the information sheet, a new information sheet was distributed to the members and the same process was repeated. Thus, in essence, the following steps were added to the NGT procedure: (1) (2) (3) (4)
Present the question to be addressed. Distribute a copy of an information sheet to each group member. AlIow group members to generate ideas silently, in writing. Ask group members in tum to state an idea briefly, and record each on a flip chart. Continue until alI ideas have been stated and recorded. (5) Repeat steps 2 through 4 for each information sheet. (6) Discuss each recorded idea for clarification and evaluation. (7) Determine the priority ofideas byhavinggroup membersindividually vote on them; derive the group decision mathematicalIy through rank-ordering or rating.
42
THE APPLICATION The Missouri Department of Mental Health (DMH) is composed of three operating divisions: the Divisions of Comprehensive Psychiatric Services, Mental Retardation and Developmental Disabilities, and Alcohol and Drug Abuse. Each division is served by a state advisory council (SAC) and a network of regional advisory councils (RACs). Members of these councils are chosen for their professional or personal interest in the clients served by the division, and include family members of clients, former clients, staff members of the DMH and other state human service agencies, staff members of community agencies with which the DMH contracts, researchers, and other human service professionals. The councils assist the respective divisions in their planning efforts . The RACs are charged with annually developing a plan that describes the needs of the regions and suggests objectives by which those needs might be addressed. The SAC is charged with collaborating with the division in the development of a state plan that lists needs and objectives for action by the division. The varying backgrounds of the council members provide an impressive compilation of experience and knowledge about the target population and the service delivery system that would be potentially invaluable to such a planning endeavor. Experience had shown, however, that these differences often served as a liability rather than an asset. It was difficult to keep all members interested and contributing to a planning process. Professional members tended to outtalk and intimidate the lay members; staff members from the DMH and those from the community agencies tended to argue points of view that were typical of their backgrounds and that tended to be unresolvable. Consumer advocate members often found it difficult to hold the floor long enough to distill from their experiences recommendations for action. The NGT was attractive to use for the purpose of compiling the council members' perceptions of the needs of a region, given that the process provides all members of the group the same opportunity to participate and to ensure equal consideration of all ideas. We also wanted to incorporate in the procedure a means that would encourage council members to review input from other sources and to consider data on the needs of the regions and the availability ofservices. For this purpose, information sheets were prepared by state and regional
43
planning staff in advance of the meetings. Each sheet provided information that might suggest ideas concerning the question posed. The question that was posed to each of the regional councils was, "What are the major issues or concerns facing your region concerning provision of psychiatric services [or mental retardation and developmental disabilities, or alcohol and drug abuse services]?" The information sheets included (1) priorities that had been set by the State Mental Health Commission, (2) priorities of the previous year's state mental health plan, (3) vendor and facility plans from the region, (4) U.S. Census information, (5) data on utilization of mental health services in the region and state, (6) data on availability of mental health services in the region and state, and (7) data on socioeconomic variables in the region and state. The information sheets were presented one at a time to the group members for their review, and input from members was solicited in the round-robin sequence for each information sheet. Finally, when all information sheets had been presented and considered, council members were asked, "What other issues or concerns face your region concerning provision of psychiatric services [or mental retardation and developmental disabilities, or alcohol and drug abuse services]?" The idea-generation phase of the NGT was then completed, and the remainder of the group process was conducted according to the instructions in Delbecq et aI. (1975).
OUTCOME
The modified NGT was helpful in generating a prioritized list of issues or concerns for each region. The process was successful in equalizing the input from all members of the councils and in ensuring consideration of all ideas. The use of information sheets provided the opportunity for all members to review information pertinent to their regions. Thus the process informed the members at the same time that it provided a nontedious means of gleaning observations relevant to the delivery of services in the region. Comments from council members and staffindicated that it was successful in providing a means for the council members, persons of diverse backgrounds, to participate in and feel part of a planning procedure.
44
REFERENCES Dclbecq, A. L, A. H. Van de Ven, and D. H. Gustafson (1975) Group Techniques for Program Planning Glenview, IL: Scott, Foresman. Lapine, L. (1987) "Using the nominal group technique in formative evaluation." Evaluation Practice 8 (August): 15-18.
The August 1987 issue of Evaluation Practice described the use of the Nominal Group Technique (NGT) in formative evaluations (Lapine, 1987). This article prompted us to share a modification of the NGT that we devised. The modified NGT served as a basis of a needs assessment using key informants. Lapine wisely urged compliance with the detailed structure of the NGT to ensure a positive outcome. We, the planning staff at the Missouri Department of Mental Health, were mindful that the benefits of the NGT would be diminished if the essential elements were disregarded. However, we felt that an additional component would improve its applicability to our planning task without sacrificing the strengths of the process. Our planning task was a complex needs assessment that we felt required that the group members have not only firsthand knowledge of the planning region, but also acquaintance with data and other pertinent materials. The modification enabled us to present these materials to the group members (our key informants) during the NGT process.
THE NOMINAL GROUP TECHNIQUE AND MODIFICATION The NGT offers a carefully structured process for conducting a group session (Delbecq et al., 1975). It is designed to provide all members of 40
41
the group equal opportunity for participation and to ensure equal consideration of all input. The NGT process begins with the presentation of a question to the group. The first phase of the NGT creates an arena for the generation of answers in response to the question. Each answer receives immediate acceptance; thus ideas are expressed that otherwise might be suppressed. An idea is not scrutinized until the second phase, when all ideas are displayed before the group members and individual ideas are seen in the context of all ideas. As a result, merit might be found in an idea that earlier would have been discounted, or an additional idea might emerge from a combination of ideas. Finally, all members receive equal vote on the rating of the importance of the finalized list of ideas. The product of the NGT is therefore likely to be better than the contribution of any individual member of the group. We modified the NGT by introducing new information to members during Phase 1, Issue Generation. Information sheets were prepared in advance of the meeting. Each information sheet provided material that might suggest ideas concerning the question posed . The information sheets were distributed one at a time to group members. The members reviewed an information sheet and silently wrote down the ideas suggested to them by this information. The group facilitator then proceeded to solicit participation from .group members and to record each idea. A "round-robin" order of participation was used in which all members were sequentially queried for ideas. After the members had exhausted their ideas based on the information sheet, a new information sheet was distributed to the members and the same process was repeated. Thus, in essence, the following steps were added to the NGT procedure: (1) (2) (3) (4)
Present the question to be addressed. Distribute a copy of an information sheet to each group member. AlIow group members to generate ideas silently, in writing. Ask group members in tum to state an idea briefly, and record each on a flip chart. Continue until alI ideas have been stated and recorded. (5) Repeat steps 2 through 4 for each information sheet. (6) Discuss each recorded idea for clarification and evaluation. (7) Determine the priority ofideas byhavinggroup membersindividually vote on them; derive the group decision mathematicalIy through rank-ordering or rating.
42
THE APPLICATION The Missouri Department of Mental Health (DMH) is composed of three operating divisions: the Divisions of Comprehensive Psychiatric Services, Mental Retardation and Developmental Disabilities, and Alcohol and Drug Abuse. Each division is served by a state advisory council (SAC) and a network of regional advisory councils (RACs). Members of these councils are chosen for their professional or personal interest in the clients served by the division, and include family members of clients, former clients, staff members of the DMH and other state human service agencies, staff members of community agencies with which the DMH contracts, researchers, and other human service professionals. The councils assist the respective divisions in their planning efforts . The RACs are charged with annually developing a plan that describes the needs of the regions and suggests objectives by which those needs might be addressed. The SAC is charged with collaborating with the division in the development of a state plan that lists needs and objectives for action by the division. The varying backgrounds of the council members provide an impressive compilation of experience and knowledge about the target population and the service delivery system that would be potentially invaluable to such a planning endeavor. Experience had shown, however, that these differences often served as a liability rather than an asset. It was difficult to keep all members interested and contributing to a planning process. Professional members tended to outtalk and intimidate the lay members; staff members from the DMH and those from the community agencies tended to argue points of view that were typical of their backgrounds and that tended to be unresolvable. Consumer advocate members often found it difficult to hold the floor long enough to distill from their experiences recommendations for action. The NGT was attractive to use for the purpose of compiling the council members' perceptions of the needs of a region, given that the process provides all members of the group the same opportunity to participate and to ensure equal consideration of all ideas. We also wanted to incorporate in the procedure a means that would encourage council members to review input from other sources and to consider data on the needs of the regions and the availability ofservices. For this purpose, information sheets were prepared by state and regional
43
planning staff in advance of the meetings. Each sheet provided information that might suggest ideas concerning the question posed. The question that was posed to each of the regional councils was, "What are the major issues or concerns facing your region concerning provision of psychiatric services [or mental retardation and developmental disabilities, or alcohol and drug abuse services]?" The information sheets included (1) priorities that had been set by the State Mental Health Commission, (2) priorities of the previous year's state mental health plan, (3) vendor and facility plans from the region, (4) U.S. Census information, (5) data on utilization of mental health services in the region and state, (6) data on availability of mental health services in the region and state, and (7) data on socioeconomic variables in the region and state. The information sheets were presented one at a time to the group members for their review, and input from members was solicited in the round-robin sequence for each information sheet. Finally, when all information sheets had been presented and considered, council members were asked, "What other issues or concerns face your region concerning provision of psychiatric services [or mental retardation and developmental disabilities, or alcohol and drug abuse services]?" The idea-generation phase of the NGT was then completed, and the remainder of the group process was conducted according to the instructions in Delbecq et aI. (1975).
OUTCOME
The modified NGT was helpful in generating a prioritized list of issues or concerns for each region. The process was successful in equalizing the input from all members of the councils and in ensuring consideration of all ideas. The use of information sheets provided the opportunity for all members to review information pertinent to their regions. Thus the process informed the members at the same time that it provided a nontedious means of gleaning observations relevant to the delivery of services in the region. Comments from council members and staffindicated that it was successful in providing a means for the council members, persons of diverse backgrounds, to participate in and feel part of a planning procedure.
44
REFERENCES Dclbecq, A. L, A. H. Van de Ven, and D. H. Gustafson (1975) Group Techniques for Program Planning Glenview, IL: Scott, Foresman. Lapine, L. (1987) "Using the nominal group technique in formative evaluation." Evaluation Practice 8 (August): 15-18.