People play an important role in improvement initiatives and the support of a wide variety of people is needed to make a change in practice.
Identifying and engaging the right people starts early. Understanding the local problem and the goal of the initiative makes it easier to identify who the initiative will impact and who can help influence the change. In general, a successful initiative requires:
An abbreviation initiative will have widespread implications for communication between healthcare providers. A successful abbreviation initiative requires clear commitment and direction from executive leadership of the organization. A project sponsor with executive authority can provide liaison with other areas of the organization that might be impacted, ensure that the initiative aligns with the strategic aims of the organization, and secure resources and overcome barriers on behalf of the project team.21
Initiatives that will require practice changes to be made in multiple organizations will be more complex. Multiple project sponsors representing each collaborating group or organization might be needed. For example, in an initiative involving a supportive living facility and multiple pharmacies that provide services to the residents, sponsors might include the care director of the facility and managers of the pharmacies involved.
Engage senior leadership as a project sponsor early by building a case for the initiative using information gathered from the literature and data to define the local problem.
Frontline care providers will be asked to change some of their long-standing communication habits and many will be resistant to this change. Clinical leaders are needed who support the initiative, are able to influence the practice of their colleagues, and can address issues that arise.21 To identify potential champions, consider which disciplines or areas of practice will be affected most by the proposed change based on your knowledge of local patterns of abbreviation use. Champions can be engaged directly as part of the project team, or serve as a resource to the team, providing a critical liaison with their colleagues when necessary.
Assign one individual to provide day-to-day leadership of the initiative. This person should understand the system where abbreviations are used and also have some quality improvement experience. This could be a quality improvement specialist, or a clinical or technical expert (e.g., nurse or pharmacist). If the project lead does not have quality improvement experience it will be helpful to have someone else with this experience either on the team or supporting the team. The project lead needs to have enough accountability and authority to work effectively with the senior leadership sponsor, clinician champions, and other members of the improvement team.
The improvement team is responsible for planning the initiative, guiding its implementation, and monitoring progress. Team membership will vary depending on the practice setting, the extent of the problem defined by local data, and the overall project goal. When the abbreviation initiative will impact physician prescribers, it is advisable to include a physician leader on the team in addition to securing champions in various specialty areas. Include representation from each of the areas potentially impacted by the proposed change in the way abbreviations are used, including management, frontline providers, and support departments. This may include:
After securing executive support for the initiative, the Pharmacy Manager assigned one of the pharmacists to be the project lead. Using results from the audit of abbreviation use they engaged the medical and nursing staff leaders, and the medical leads for medicine and surgery as key champions. With assistance from the champions, a physician and surgeon were identified to join the project team, as well as nursing managers from the surgery and medicine units, a pharmacy technician, and frontline nurse.
After securing executive support for the initiative, the Director of Care assigned her nurse educator to be the project lead. The facility medical advisor and pharmacy manager were engaged as key champions. With assistance from the champions, a nurse manager, frontline care provider at the facility, pharmacist, and family physician were invited to join the team.