Step 2: Create the Guiding Coalition, Part 2

Successful change demands the right team at the top.  Representation of all key stakeholders who believe in the value of the ASP is necessary, e.g. individuals from various clinical departments, laboratory and administrative areas.  The structure of the program may be organized into:

  • an operational team (day-to-day workings of ASP)
  • an oversight committee (executive sponsors to give advice, keep the team on course, trouble shooting, and advocate for sustained resources)

Figure 2:  Prototype of the structure of an antimicrobial stewardship program

Both groups should meet independently and regularly with the program director (or lead ASP physician) reporting to the oversight committee.  Engaging facility leadership helps to prioritize resources.  Selection of individuals as team members should be based on the four characteristics of a successful team as identified by Kotter:  position power, expertise, credibility and leadership.  This strategy also provides individuals with a sense of ownership and responsibility to the program.


  • Morris AM, et al. Healthc Q 2010;13(2):64-70.
  • Kotter JP. Leading Change. Boston:  Harvard Business School Press, Boston 1995.

Next:  Steps 3 and 4:  Create and Communicate the Vision