American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Step 2: Building the Foundations

Finding Champions and Collaborators within your Institution and the Community

Understand Your Institution

  • Role and reputation: Change the Administration’s perception regarding the role of the hospital.
    • Establishing a program geared towards vulnerable populations can boost hospital optics.
  • Public relations: The “roll out” of an HVIP program could be a media event, creating an opportunity to engage the mayor, CEO, or city officials in this activity.
  • Social services: Meet with the Social Services Department to find ways the program can partner and be symbiotic.
  • Public safety/security: Understand their concerns and how a violence prevention program could help temper emotions in the community after a violent event.
  • Hospital staff: They are a part of the community. Educate hospital staff highlighting interpersonal violence as a public health issue that can be addressed in the hospital setting.
  • Assess accountability of the Victims of Crime Act in your institution.
    • Is it present and utilized?

Identify Key Community Stakeholders

  • Local community-based organizations: At-risk communities should be part of the development and implementation of the program. Relationships with local organizations can help overcome the community’s inherent lack of trust.
    • Attend meetings, identify community leaders, and find CBOs that offer risk reduction resources. Selecting the HVIP case managers should be a community-driven process.
    • Reincorporate people into their communities in a healthy way.
  • Community partners will differ depending on the target population and local resources.
  • Community partners may indeed supply case management services in the beginning when you are unable to support case managers.

Principles in Practice

Many violence intervention programs begin by introducing the concept at staff meetings, leadership committee meetings, and community based organizations. Typically, these presentations are geared towards breaking barriers and engaging each set of stakeholders in a way that encourages partnerships and speaks to their interests and concerns. These efforts, therefore, are best individualized based on what resonates with specific groups. For example, the mayor may not only want to understand the potential human value, but may also want to hear about the financial impact. Similarly, a community organization may want assurance about how the community will be a vital part in the program itself.

An example/template for the introductory powerpoint presentation to HVIP stakeholders is available for download.

Potential Pitfalls

When starting an HVIP, it is important to realize that there is often a sense of “normalization” of violence to the people most susceptible to it. Breaking those barriers and resetting expectations during the start-up phase is imperative. Changing the culture inside and outside of the hospital setting requires persistent reminding that violence is never acceptable or normal. This helps assure buy-in and acknowledges that the risk factors are modifiable.

It is important to understand the platform of different stakeholders and that a program’s success is jeopardized if critical stakeholder buy-in does not occur. Lack of buy-in occurs for a number of reasons:

  1. Messaging to particular groups is not in line with priorities of a particular stakeholder
  2. Stakeholders feel overlooked during the development and implementation
  3. Priority items of particular stakeholders are not addressed.

For example, a CEO of a hospital may want to know the cost effectiveness of such programs, and the impact the program will have on the hospital’s image within the surrounding community. If programs are not prepared with that information, a CEO may not feel persuaded to support the program. Finally, identifying an in-hospital champion, usually a committed trauma surgeon or emergency medicine physician is an essential element for advocacy. Similarly, a key community partner is important for developing essential partnerships when securing risk reduction resources (Step 3).

It is important for the in-hospital champion to have an open door dialogue policy, so that critical concerns from either hospital staff or community based organizations can be addressed in a timely fashion.