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

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.