Visualizing implementation: contextual and organizational support mapping of stakeholders (COSMOS)

Abstract

Background: While stakeholder mapping is common in public policy, social sciences, and business management, this tool has not often been used in healthcare settings. We developed a new method of healthcare stakeholder mapping, which we call Contextual and Organizational Support Mapping of Stakeholders (COSMOS), to identify and assess key stakeholders in an implementation project. Stakeholder mapping allows the implementation team to assess and visually display all relevant stakeholders, their support for the project, and their ability to facilitate-or hinder-project implementation. Methods: The COSMOS model was developed to visualize the stakeholders involved in a hospital-based study conducted from 2013-2016. In this study, a new screen prompt and order set were embedded in the electronic health record to facilitate the identification and treatment of adult smokers admitted to the hospital. Physicians were the unit of randomization; physician behavior and tobacco quit rates among patients were followed for 1 year. Qualitative interviews with hospital administration, physicians, and information technology (IT) personnel (n= 24) were conducted to identify the components and characteristics of the COSMOS. Results: The COSMOS consists of an organizational chart identifying all key stakeholders, with manipulation of colors and borders of the component boxes to indicate stakeholder support for the implementation project, and degree of criticality to its success. The COSMOS visualization informed the team's subsequent work by identifying potential impediments that might require additional attention to garner and maintain support throughout the project. In addition, the approach has proved to be a useful tool to explain these concepts to trainees in implementation science. Conclusion: The COSMOS schematic provides a visually rich means of identifying stakeholders, understanding their relationships to each other, displaying their level of support for the proposed implementation, and noting their criticality to the effort. The COSMOS can support researchers, project teams, administrators, and others engaged with implementation science-related work in healthcare, as well as other fields such as education, government, and industry.

WICID framework version 1.0: criteria and considerations to guide evidence-informed decision-making on non-pharmacological interventions targeting COVID-19

“…Using a sample of NPIs with broad societal implication as a starting point (closure/reopening of schools, closure/reopening of businesses, and ‘shelter-in-place’ regulations), we will include opinion pieces, position papers or press statements aimed at informing political decision-making on these measures. A first set of stakeholder group clusters (eg, social and welfare organisations) will be selected based on an initial brainstorming phase and stakeholder mapping 56 and expanded in an iterative snowballing process. While it will not be feasible to cover all relevant organisations within a given cluster, we will analyse a heterogeneous sample which will be expanded in an iterative process based on the assessment of saturation.…”

“…Informed by the logic model, (3) an identification of relevant stakeholders should be conducted, ideally in the form of a comprehensive or focused stakeholder mapping. 56 Next, (4a) those involved in the decision-making process need to define criteria which are assumed to be of relevance for deliberating on the measure. This can be done for example, by selecting individual aspects from within each criterion and adapting them to the context at hand.…”

WICID framework Version 1.0: Criteria and considerations to guide evidence-informed decision-making on non-pharmacological interventions targeting COVID-19

“…A first set of stakeholder group clusters (e.g. social and welfare organizations) will be selected based on an initial brainstorming phase and stakeholder mapping 58 and expanded in an iterative snowballing process. While it will be not feasible to cover all relevant organizations within a given cluster, we will analyze of a heterogeneous sample which will be expanded in an iterative process based on the assessment of saturation.…”

“…by exploring the causal pathways from different perspectives, assessing the implications for different affected population groups, or using the criteria and aspects to assess its comprehensiveness). Informed by the logic model, (III) an identification of relevant stakeholders should be conducted, ideally in the form of a comprehensive or focused stakeholder mapping 58 . Next, (IVa) those involved in the decision-making process need to define criteria which are assumed to be of relevance for deliberating on the measure.…”

Leveraging implementation science to advance antibiotic stewardship practice and research

“…It is also helpful to understand the relationships among the stakeholders, the roles they might play in facilitating or hindering implementation, which stakeholders have access to "levers" of change in the setting, and stakeholder levels of interest in and commitment to the proposed project. 39 Stakeholder analysis methods can be used to systematically elicit this information using a combination of research techniques. 40,41 Ideally, stakeholders are engaged from the planning process through the end of the project, and they weigh in on all aspects of study design and conduct, including implementation strategies and outcomes.…”