Public health is a multifaceted field that brings together stakeholders from diverse backgrounds, often with differing or competing interests. Yet, collaboration and stakeholder buy-in are essential to driving effective public health interventions.
But what happens when stakeholders cannot reach an agreement? Decision-making processes can become stalled, jeopardizing the success of critical projects. As public health professionals, our role isn’t to dictate solutions but to facilitate problem-solving through expertise, collaboration, and evidence-based tools.
Here are three proven models that can help navigate complex decisions and align stakeholders effectively:
- Problem Structuring with Strategic Options Development and Analysis (SODA)
The first step in any decision-making process is ensuring that all stakeholders have a shared understanding of the problem at hand. This is especially critical in public health, where problems are often complex and require diverse input. Achieving this shared understanding involves making the problem explicit before progressing to solution design and agreement.
Strategic Options Development and Analysis (SODA) is a decision-support tool designed for precisely these scenarios. It helps groups of stakeholders make sense of intricate challenges and collaboratively in order to develop a range of potential solutions. By integrating diverse perspectives and expertise, SODA not only clarifies the problem but also mitigates conflicts of interest and fosters a commitment to addressing the issue collectively.
At the core of SODA is cognitive mapping, a psychological technique that visually represents the concepts, ideas, and relationships of individuals or groups. SODA consists in drawing “cognitive maps” for all the stakeholders involved in the decision-making process to elicit the way they are thinking about the problem. The individual maps are then merged into a strategic map incorporating these views which acts as a powerful tool for facilitating discussions, enabling stakeholders to identify connections and dependencies within the problem space.
To implement the SODA model effectively, a skilled facilitator is essential. In a workshop setting, the facilitator plays a critical role in fostering collaboration, managing differing viewpoints, and guiding the group toward consensus. SODA’s qualitative nature makes it especially valuable in the early stages of problem-solving, laying the groundwork for subsequent, more quantitative approaches.
Here is a visual example of a cognitive map. Each node represents a concept (e.g., “Health Infrastructure,” “Funding”), and the lines show relationships between these concepts, indicating how one influences or relates to another. This kind of map helps stakeholders visualise connections and dependencies, fostering a shared understanding of complex problems.
- Structured Decision-Making with Decision Trees
Decision trees are a versatile and analytical tool that enables stakeholders to evaluate multiple courses of action, their potential outcomes, and associated risks or benefits. In public health, where decisions often involve uncertainties and trade-offs, decision trees provide a systematic approach to breaking down complex problems into manageable components.
This model operates by capturing a single catch-all value—referred to as the utility score—for each option, making the decision-making process explicit and transparent.
How Decision Trees Work
- Define the Decision Problem:
Start by clearly articulating the decision to be made and its objectives. For instance, deciding whether to invest in community clinics or telehealth systems to improve access to care.
- Map Out Possible Actions:
Represent all potential actions or options as branches of the decision tree. For example, the options might include “Expand Vaccination Programs” or “Focus on Health Education Campaigns.”
- Identify Outcomes and Probabilities:
For each branch, map the possible outcomes (both positive and negative) and assign probabilities based on available data, historical trends, or expert judgment. For example, expanding vaccination might have a 90% likelihood of achieving herd immunity within a specific timeframe.
- Estimate Payoffs:
Assign a utility score to each outcome, reflecting its desirability, cost, or impact. These payoffs can include financial costs, health outcomes, or social benefits, depending on the context.
- Analyze the Tree:
Calculate the expected value (utility score) for each option by multiplying the payoffs by their probabilities and summing the results. This calculation highlights the most optimal course of action based on a balance of benefits, risks, and costs.
Strengths of Decision Trees
• Resource Efficient:
Decision trees are relatively simple to develop and require minimal time and resources, making them an accessible tool for decision-making in resource-constrained settings.
• Clear and Visual:
The visual structure of decision trees promotes clear communication, making it easier to explain the rationale behind decisions to diverse stakeholders.
• Risk Assessment:
Decision trees quantify risks and benefits, enabling stakeholders to compare and evaluate options systematically. This evidence-based approach supports informed decision-making, even in uncertain situations.
- Shortlisting the Best Options with Multiple Criteria Decision Analysis (MCDA)
Multiple Criteria Decision Analysis (MCDA) is indicated as a technique that lends itself well to decision-making problems involving options that need be analysed against a set of multiple qualitative and quantitative criteria.
By applying the MCDA model, the decision-making process becomes more rational, robust, and transparent. This structured approach enables stakeholders to evaluate options systematically, ensuring that decisions are grounded in agreed-upon objectives and priorities.
Moreover, the transparency of MCDA fosters greater alignment and commitment among stakeholders, as the process emphasizes fairness and consistency. By making the evaluation criteria explicit and involving all participants in the process, MCDA helps build consensus and trust, paving the way for more effective and sustainable outcomes.
Steps in the MCDA Process
The first step in the process is to develop a performance matrix. This matrix enables stakeholders to compare available options against a set of performance criteria, ultimately arriving at a shortlist of viable solutions.
To begin, stakeholders must agree on the overall objective of the process. This agreement serves as the foundation for identifying potential decision options based on the agreed objectives and the resources available.
Once the options are identified, they need to be scored to facilitate comparison. This requires stakeholders to define the criteria that reflect the overall objectives of the process and will be used to evaluate the options.
The next step is to collect the necessary data to inform the scoring process. This involves a combination of:
• Direct observation,
• Data analysis, and
• Subjective judgments from stakeholders.
The resulting performance matrix provides a structured and transparent basis for comparing options and supports collaborative decision-making by aligning evaluations with the shared objectives of the stakeholders.
Shortlisting Options
Several techniques can be applied to shortlist viable options during the decision-making process. These methods help refine the available choices by systematically narrowing down the list to the most feasible and acceptable alternatives.
- Sequential Elimination
Sequential elimination involves systematically removing options that are dominated by others until only the dominating options remain. This technique is particularly useful for quickly discarding unfeasible choices and serves well as an initial step in the shortlisting process. Once a list of feasible options is established, stakeholders can apply more detailed techniques for further evaluation.
- Satisficing
Satisficing sets minimum standards for acceptability on each criterion and eliminates any option that does not meet these thresholds. Once stakeholders agree on these minimum standards, the process is straightforward and objective, effectively “weeding out” options that fail to meet the agreed criteria.
- Weighting
Weighting is used when the importance of criteria varies among stakeholders. This technique assigns weights to each criterion, giving more influence to certain factors. Options that perform poorly on highly weighted criteria are downgraded accordingly. For this method to work, stakeholders must agree on the weights attributed to each criterion.
Beyond aiding in shortlisting, the weighting process also encourages stakeholders to explore and articulate their value systems. This makes it particularly useful in situations where political interests or priorities differ, as it fosters a deeper understanding of varying perspectives.
By applying these techniques—individually or in combination—stakeholders can streamline the shortlisting process and focus on the most viable options, paving the way for more structured and collaborative decision-making.
Achieve Better Outcomes Together
Navigating complex decisions and aligning stakeholders doesn’t have to be daunting. Tools like SODA, decision trees, and MCDA can help streamline your decision-making processes, ensuring project success and impactful results.
