Establish committee of key stakeholders During the planning process, convene a committee of key stakeholders. Stakeholders are individuals or groups of people who are important to the success of your project and include those who can affect, and are affected by, your program. They are critical to success and must be defined early on. This could include department leads, front-line staff, patients or community members. Establish a roundtable open forum with these stakeholders to obtain input and buy-in for optimal success and sustainability. Meet regularly if possible. Brainstorm with your team to see who is actively involved, whose work is impacted by your intervention, and who supports your program with data, supplies or human resources. Determine the stakeholders’ commitment or resistance to your intervention. Take time to ask questions, such as: • What matters most to you in this work? • Who do you think is essential to make this program successful? • What concerns do you have related to this program? • What barriers exist for your engagement in this program? This is an opportunity to understand stakeholders’ wants and needs. Once you have completed this listening exercise, develop strategies to address what matters most to them. The goals and solutions that your core group identifies may not align with the priorities and goals of the stakeholders. To find alignment among stakeholders, you must listen first. Synthesize stakeholder conversations and report back to them. During this report out, actively use “you mentioned,” “you said” and “I heard” statements to reflect their comments and concerns, and to communicate that their priorities have been incorporated into the program plan. Stakeholders should be credited with their program contributions and designs. Enabling active inclusion improves future engagement in the program and ownership of the implementation. Consider engaging information technology from the beginning to make changes in the electronic medical record (EMR) and order sets, etc. Chaplaincy, volunteer teams, and dietary and environmental services may also play a huge role in early development and may be influential in motivation, setting the daily agenda, and serving as teammates interacting with patients in support roles. Address logistical issues for startup Risk assessments — One set of key logistical considerations during planning includes identifying validated risk assessment instruments. These instruments will help define and assess the population for issues, such as functional status, independence level, frailty and psychosocial well-being. You will need to decide what tools to use, who will perform the evaluation, and how the workflow will be organized. Processes or protocols may also be needed to achieve consistency in documentation. There are several vulnerability assessment instruments available for use, but each should be evaluated by your team to determine which tool best fits your team’s and patients’ needs. The selection of tools should consider how to include them in the workflow to maximize compliance. The scales or scores will be used to trigger consultations or suggestions for care based on the answers that patients provide to the questions. For example, the FRAIL questionnaire19 has a question regarding weight loss. If a patient answers positively to experiencing weight loss, a consultation with a registered dietitian is triggered. The registered dietitian will then meet with the patient that same day to review supplementation, calorie needs, food choices, food insecurity or access, and any other issues related to nutrition that apply to the patient. Integrating these assessments into the EMR with auto-triggers for follow-up actions will help ensure consistency of implementation. 5
