Table. Fundamental elements and principles of successful medicines stewardship programs ^{5 - 8} .

Fundamental elements of successful medicines stewardship	Underlying principle	Practical implications
Multidisciplinary leadership team	Stewardship programs are often administered by a dedicated stewardship lead or officer. However, support from a multidisciplinary leadership team is essential to provide a holistic system perspective that helps ensure the program achieves its intended aims and can be implemented sustainably.	• Leadership team members should be chosen to represent the specialties and patient population that the specific stewardship program is trying to address, and reflect the expertise and skills required to support program functions. • Essential skills and knowledge for team members include clinical experience and expertise, clinical governance, medication safety and quality use of medicines principles, and accreditation processes. • The leadership team should ideally include core representation from the organisation’s executive, medical, nursing, pharmacy and consumer groups.
Stakeholder engagement	Medicines stewardship programs should be designed with the whole system of care in mind and should traverse transitions of care. Engagement of relevant organisational stakeholders and external partners is essential in understanding how to design or adapt a stewardship model for successful implementation within the local context.	• Stakeholder mapping and analysis help identify key players who hold interest and influence over the program’s success and inform how the program is communicated and reported. • Stewardship program stakeholders may include clinicians, managers, administrative staff and consumers. Engagement of relevant external stakeholders is essential to ensure the continuity of stewardship changes and outcomes.
Tailored communication strategy	Stewardship programs require a tailored communication strategy to provide timely, effective and appropriate information to support program functions.	• Methods of communication are tailored to fit the specific purpose (e.g. to raise awareness, promote specific initiatives, issue program updates or provide feedback about successes and failures), as well as the intended audience. • A communication strategy should leverage existing organisational structures and networks.
Proven methodologies in behavioural change and implementation science	Successful stewardship programs adopt proven methodologies in behavioural change and implementation science to achieve clinical practice improvement.	Examples include: • using education strategies that are tailored to the target audience, incorporate competency standards, include evaluations of education activities and report feedback about successes and failures • developing clearly defined interventions that are trialled and optimised in one or a few selected settings, and then replicated systematically in other settings with local tailoring • selecting clinical champions to act as a knowledge and skill resource to peers and to provide motivation and advocacy to facilitate the adoption of stewardship interventions.
Ongoing monitoring, evaluation and reporting	Ongoing monitoring and reporting of defined measures or quality indicators are critical for evaluating the effectiveness of stewardship strategies and identifying opportunities for improvement. Medicines stewardship should evaluate clinical processes as well as consumer outcomes.	A combination of measures should be used, such as: • structural measures – governance structures, drug formularies or guidelines • process measures – compliance with prescribing guidelines, or drug utilisation data • outcome measures – mortality, readmission rates, or patient experience reports • balancing measures – adverse events due to an intervention.