Method
| The Invitees | ||||||||||||||||||
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The goal of the symposium was to elicit response to the research questions, above, in the context of a future pandemic. Ideas and observations drawn from personal experience were sought from health professionals who either worked in a variety of areas and organizations within the local healthcare system, or who worked in organizations positioned to influence the effectiveness and efficiency of local healthcare systems. Those invited to participate in the symposium came from three camps: Medical Officers of Health from Ontario's 36 Public Health Units; Primary Care Physicians who had been referred by the Ontario College of Family Physicians, the Ontario Medical Association or their local Public Health Unit, and who had been interviewed during Phase-1; and, representatives from those provincial and federal organizations that can influence local healthcare policy. Fifty invitees attended the symposium of which 44 were considered 'active or voting participants'; the remaining six 'non-active participants' included additional observers from the MOHLTC, the CIHR and members of the research team who did not participate in the decision-making activities. It was believed that this group, with their different combinations of public health and primary healthcare related expertise, being brought together under the conditions of a managed symposium, would result in a diverse, dynamic and, ultimately, a very revealing discussion. The active participants came from the following categories (participants are listed in Appendix 1):
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| Seating Arrangements | ||||||||||||||||||
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As part of the consensus building process (described below, in detail), participants were to be seated at tables of 5 to 7 people. It was reasonable to expect that the experiences of primary care physicians and public healthcare practitioners would be impacted by local characteristics such as the population size, population density, geographic size and the relative 'rurality' associated with each PHU, and that the policy suggestions submitted by each table should reflect the opinions of participants who work in regions sharing similar characteristics. Thus, it was important that participants were grouped by the similarity of their PHU's characteristics. Participants therefore seated according to Public Health Unit profiles as based upon established public health peer groups (MOHLTC, 2009; Statistics Canada, 2008):
While it was not possible achieve a even mix, precisely, tables were arranged so that people from Metro or Urban areas were grouped closely together, and those from very Northern and Mainly Rural areas were grouped together. |
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| Setting the Stage - The Presentations | ||||||||||||||||||
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To initiate the symposium a Dr. Ian Gemmill (MOH, KFL&A-PHU) welcomed the participants with some opening remarks. Mr. Eric Lockhart then described the objectives and the methods that would be used during the symposium. A series of presentations followed to provide an overview of the project, to date, and contextualized the issues prior to each discussion of the symposium themes (Table 1, below). As an introduction, Dr. Masotti (KFL&A-PHU, Queen's University) followed with background information on the objectives of the overall research project, gave preliminary results from the Phase-1 interviews, and outlined how the research questions for the symposium were developed. Mr. Michael Whelan (Sr. Epidemiologist, MOHLTC) then provided an overview of the epidemiology of the H1N1 pandemic that swept Ontario in two waves during 2009/10. This was followed by theme specific presentations by Dr. Ian Gemmill (MOH, KFL&A-PHU), Ms. Adrienne Hansen-Taugher (Emergency Planning Coordinator, KFL&A- PHU), Dr. Michael Green (Queen's University, Centre for Studies in Primary Care) and Dr. Kieran Moore (Queen's University and KFL&A-PHU). The visual accompaniment for each presentation is presented in Appendix 4.
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| The Process | ||||||||||||||||||
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With the stated goal of the symposium being to elicit response to the research questions, the services of Mr. Eric Lockhart were recruited. As Associate Director of the Queen's University School of Business Executive Decision Centre, Mr. Lockhart designs and facilitates meetings using group decision support technology as well as other more traditional meeting processes. In this instance, he directed the symposium activities, using a modified Nominal Group Technique combined with an Electronic Meeting System approach. (Jones & Hunter, 1995; Lloyd-Jones et al., 1999) The Electronic Meeting SystemEach of the theme specific presentations was followed by a facilitated discussion, consensus building exercises and response ranking activities. Criteria for evaluating individual responses to the research questions were not pre-determined so as permit free-ranging discussions, and not limit participants in their responses. The facilitator directed the participants using an electronic meeting system-based (EMS) approach that combines expert facilitation with a state-of-the-art group decision support capability and enables groups to generate ideas rapidly and to accelerate the process of consensus building. The system consists of a network of laptops accessing software designed to support idea generation, idea consolidation, and idea evaluation and planning. As a tool, it supports but does not replace verbal interaction. Typically, 25% of participant interaction takes place on the computers. Reported benefits of the EMS approach suggest that, as a more structured process: meeting times can be cut in half; rates of participation increase significantly; there is better generation of ideas and evaluation of alternatives; and, deliberations are documented automatically (Queen's, 2009). The 'EMS' approach both complements and augments the modified Nominal Group Technique that was used to elicit and rank responses, during the symposium. The Modified Nominal Group TechniqueA modified version of the Nominal Group Technique (NGT) was used as the underlying group meeting methodology Jones and Hunter (1995), further illustrated by Lloyd-Jones et al., (1999), describe the strength of this consensus building technique as the "ability to overcome some of the disadvantages normally found with decision making in groups or committees, which are commonly dominated by one individual or by coalitions representing vested interests". Carney, et al., (1996) further suggest strengths of the NGT:
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| Data Gathering and Analysis | ||||||||||||||||||
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The gathering and analysis of data during the symposium consisted of three main steps. The first two took place during the symposium, and the third step was completed subsequently, in the days that followed the symposium. Data Gathering - Step One:During the four separate whole group sessions a modified Nominal Group Technique (see Table 2, below) was employed, utilizing an electronic meeting system to elicit, record and rank responses to the research questions. Following each presentation, each participant was requested to write out his or her ideas, issues or policy suggestions addressing the research questions under consideration and submit them to the members of their tables. Following a small group (individual table-based) consensus process, the members of each table then ranked the table's responses. This became the 'Small Group List'. The top 5 ranked responses were then entered into the table's computer, and submitted electronically to the central EMS computer. Responses submitted by all the tables were then displayed on a large screen for all participants to review and evaluate. The facilitator then worked with the group as a whole (i.e., all 44 active participants) to identify and eliminate duplicate responses, and then to match and, with language changes where appropriate, merge similar ideas. This created the 'Large Group List' for the given research question. Data Gathering - Step Two:
Under the guidance of the facilitator, the group as a whole then discussed all the responses on the Large Group List. Each participant then, individually, ranked these responses and entered his or her top 1, 4 or 5 preferences into the table's computer (the number of choices being stipulated by the facilitator) which, again, were anonymously submitted to the central computer. After all participants had submitted their choices, the EMS program summed the votes and presented the Large Group List responses as ranked by the group as a whole. The data gathering steps were repeated for each of the research questions.
Content Analysis - Step Three:Following the symposium, all the responses and voting results from the data gathering sessions were tabulated and presented in a computer generated symposium report by the Queen's Executive Decision Centre. An evaluation of the report was undertaken to identify emerging themes and synthesize the main 'take-home' messages.
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