Democratic prioritization of maternity care: a rational basis for planninga clinical effectiveness programme

Background The aim of the study was to evaluate the use of a democratic pro cess for prioritizing the ASQUAM (Achieving Sustainable Quality in Maternit y) clinical effectiveness programme. Methods Twenty-two improvements in the standards of maternity care were cho sen as top-topic priorities at the 1996 and 1997 ASQUAM meetings. We wished to assess the relative priorities of local and national delegates, by comp aring their voting patterns at the two meetings. The setting was North Staf fordshire ASQUAM prioritization days, and the subjects were all the delegat es at the 1996 and 1997 ASQUAM meetings. Main outcome measures were compari son of numbers of votes cast by local and national delegates for each of th e 20 topics presented at the two ASQUAM meetings, and proportions of the 11 top-topics decided at each meeting that were chosen by local and national delegates. Results In 1996, significantly more local than national delegates voted for two topics related to maternal mortality or morbidity (incontinence and hy pertensive diseases of pregnancy), but there were no statistically signific ant differences between the proportions of votes cast for any of the other 18 topics presented on the day. Indeed, local delegates had prioritized 11/ 11 of the final top-topics, and only one was omitted by the national delega tes (10/11). In 1997, significantly more national than local delegates vote d for three topics relating to professional stress levels, user involvement in working groups and antibiotic prophylaxis, but there were no statistica lly significant differences between the proportions of votes cast for any o f the other 17 topics presented on the day. Again, local delegates had prio ritized 11/11 of the final topics, with only one being omitted by the natio nal delegates (10/11). Conclusion There appeared to be a remarkable concordance between local and national delegates at both meetings, suggesting an underlying rationality t o decision making. We believe this to be a reflection of the process of car eful evaluation of outcome and intervention supported by the protection of a secret ballot, allowing free expression of individual's values.