• Potential stakeholders in a healthcare facility (incident management, public health, local, leadership, advisory groups, medicine, surgery, populations, settings)
• Stakeholder analysis table (doc) may be used to think through how to attain stakeholders’ commitment

Quick Implementation Guide

Sheet 3: Stp 2 – Who (stakeholder, team)

• Who needs to be involved in the implementation process
  • Columns B-D pre-populate from ‘Examples’ (Sheet 1), columns C-E
  • User enters info for columns G-K
    • Based on identified stakeholders (facilitators, champions, barriers)
    • Identifies overlap with HICS roles
    • Includes column to identify ways role/individual may help team

Team-Based Approach^[i]

The table above helps identify those who likely should be involved in developing and rolling out policies and practice changes.

The team-based approach in implementation science often is referred to as an “implementation team.” The implementation team is a group of people who commit to work together, provide perspective, input, and discussion, and aim to roll out decisions or policies as a united front.

When HICS Is Activated

The hospital incident management team (HIMT) manages the Hospital Incident Command System (HICS).

The healthcare epidemiologist typically serves in the role of medical-technical specialist in domains relevant to infection prevention, infectious diseases, and antimicrobial stewardship. Healthcare epidemiologists are brought in to the command structure based on the type of crisis. In outbreaks and pandemics, healthcare epidemiologists participate regularly.

When HICS is activated, the HIMT serves many of the functions suggested for an implementation team.[v] HICS facilitates initial decision-making and lends authority. The hospital epidemiologist may utilize the HIMT to gain input from its officers, buy-in from leadership, and resources needed to implement practice changes and new policies to handle the crisis. HIMT members’ responsibilities may be divided up differently depending on facility:

• Incident Commander: oversees operation, determines which parts of incident management plan are activated
• HIMT Officers and/or Chiefs (Public Information, Safety, Operations, Planning, Finance/Administration, Logistics)
  • Public Information Officer (PIO):
    • Internal messaging (leadership and staff)
    • External messaging (patients, media, oversight groups)
    • Writing/editing/recording/filming/printing/IT
  • Liaison Officer:
    • Coordination with public health
    • Legal and regulatory considerations
    • External messaging (with PIO)
  • Safety Officer:
    • Resource pool
    • Responsible for safety of hospital staff, visitors, and patients
    • Monitors response and anticipates hazardous conditions or situations
  • Operations Section Chief:
    • Privacy
    • Informed consent/universal consent
    • Crisis standards
  • Planning Section Chief:
    • Information technology:
      • Supportive infrastructure
      • Electronic health record
      • Electronic communication
    • Research
    • Report writing
    • Data collection/analysis
    • Program evaluation
  • Logistics Section Chief:
    • Procurement
    • Supply chain
  • Finance/Administration Section Chief:
    • Human resources (HR)
    • Unique account to track expenses related to event
  • Medical-Technical Specialist(s): subject matter experts (SMEs) as needed for particular topics/issues, input into practice/intervention development

Additional Team Members

In addition to working with the HIMT, those responsible the decision need to take into account stakeholders’ knowledge, attitudes, and beliefs in communicating how the decision was reached and the rationale behind it.

The concept of the “implementation team” helps approach this need systematically. Individuals on this team may contribute different skills or perspectives. Some may help to liaise between the team and personnel/departments; some may provide support (administrative, IT, communications); some may represent facility leadership.

Due to time and resource constraints during a pandemic, you and your team members may need to concentrate on the subset of responsibilities. The below list provides an overview of who may be involved, and what they may do, but the composition should depend on your needs.

• Lead/Co-Lead (decision-makers and team lead(s); creates team, articulates goals/vision, defines tasks and responsibilities and balances workload within team, manages and allocates resources, facilitates information sharing, encourages team members to work together, facilitates conflict resolution, role models teamwork behaviors)
• Administrative support (facilitates correspondence, record-keeping, meeting logistics)
• Clinical champion (face of practice/policy, serves as resource for education, liaison between department and team; trusted person by/in leadership role; can help team understand values, culture, barriers, opportunities, pathways, key motivators)[iii] [iv]
• Department director(s) (refine standard operating procedures, including electronic and in-person set-up)
• Nursing leaders (guide clinical workflow review, work with department director on standard operating procedures)
• Facility or institutional leadership (sponsor team/efforts, programmatic support)
• Frontline personnel
• Information technology (IT resources, EHR)
• Lab representative
• Researcher(s)
• Practice intervention developer
• When HICS is not activated:
  • Program manager (development plan, record-keeping of decisions, situation, modifications, identifies task-related support/assistance)
  • Human Resources (HR)
  • Legal (privacy, research, informed consent/universal consent, crisis regulatory standards)
  • Occupational Health
  • Operations
  • Public Health
  • “Resource Pool” (identifies census areas and distributes staff to higher traffic tasks, e.g. front desk, visitor or employee screening, etc.)
  • Procurement/Supply Chain
  • Communications/PR (writing/editing/recording/filming/printing/IT)
  • Subject matter experts (SMEs) as needed for particular issue/topic

Individually or as a group, team members should be:[ii]

• Trusted by and connected to a stakeholder group(s)
• Committed to goals of team
• Facilitators of social exchange
• Perceptive of group(s)’ knowledge, attitudes, beliefs, motivations, behaviors, and norms
• Able to identify barriers and facilitators to the changes
• Able to provide input into how to adapt interventions to a particular group
• Able to build linkages between groups
• Able to anticipate needs and develop/adapt solutions
• Able to identify, install, and/or maintain infrastructure necessary for the change
• In role(s) with power to enact change
• Able to participate in/understand data analysis and reporting
• Able to observe, report, and help the refine approaches
• Able to engage in data-based and/or practical decision making
• Assess and report on key outcomes
• Models of courage, adaptability, resilience, transparency, and understanding

Sample team member invitation letter.

[i] Higgins, M.C., Weiner, J. and Young, L. (2012), Implementation teams: A new lever for organizational change. J. Organiz. Behav., 33: 366–388. doi:10.1002/job.1773 https://onlinelibrary.wiley.com/doi/abs/10.1002/job.1773

[ii] AHRQ TeamSTEPPS Pocket Guide 2.0 https://www.ahrq.gov/teamstepps/instructor/essentials/pocketguide.html#keyprin ISBN 1-58763-191-1, Revised December 2013, Publication: 14-0001-2, Previous Publication: 06-0020-2

[iii] ORTP: “Finding Champions” https://ortp.guidelinecentral.com/cni_toolkits/champions/

[iv] Pronovost PJ, Berenholtz SM, Needham DM. Translating evidence into practice: a model for large scale knowledge translation. BMJ. 2008;337:a1714. Epub 2008/10/06. PubMed PMID: 18838424.

Klompas M, Branson R, Eichenwald EC, Greene LR, Howell MD, Lee G, et al. Strategies to prevent ventilator-associated pneumonia in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol. 2014;35 Suppl 2:S133-54. PubMed PMID: 25376073

[v] May, L. MITIGATE Tool Kit: http://shea-online.org/images/priority-topics/MITIGATE_TOOLKIT_final.pdf