Start-Up

Use the stakeholder analysis from Goal 1 to identify the representatives across departments (e.g., clinical, finance, information technology, operations, and human resources) who you will need to work with to implement your program. Include the following leadership roles, as applicable:

• Scientific leadership, such as a brain health expert. This role requires someone with a track record of expertise in brain health and the ability to set clinical standards and decision criteria. They should possess scientific leadership skills and have the ability to influence the program's direction based on their knowledge and experience.
• Health system leadership. This role involves providing leadership and advocacy within the health system. The person selected should have presence and influence at the executive leadership level. Their responsibilities include ensuring alignment between the implementation and sustainment of the program and the overall healthcare system goals.
• Clinical operations leadership. This role requires in-depth insight into clinical operations including clinic and staffing capacity and a comprehensive understanding of how clinics function across the healthcare system. The selected person should have strong project management capabilities and be able to navigate the complexities of the healthcare system to ensure the successful execution of the program. It’s important that clinical standards set by a brain health expert can be translated and implemented in a way that will see buy-in and collaboration from other healthcare providers.
• Project manager who is responsible for the day-to-day operations of the program. This role includes oversight of the execution of the program implementation.
• An implementation coach who can provide guidance and act as the liaison between the on-the-ground and managerial teams. This role can facilitate the administration, planning, and implementation of your early detection program.

Note: You may identify additional potential key stakeholders from within your organization or by engaging with other partners (e.g., local advocacy organizations and patient support groups, elder care organizations, government stakeholders, etc.).

• Refer to the key messages in your program proposal from Goal 2 when recruiting key stakeholders, champions, or potential sponsors to articulate the value of implementing an early detection program.
• Recognize that your key stakeholders may be experts in brain health or have related experience. Leverage their experience and knowledge when creating your value proposition and talking points regarding early detection of cognitive impairment.
• Understand the knowledge gaps between team members regarding the value of the early detection program, and provide training for alignment. Effective training should consider the level of knowledge of stakeholders, the key messages and information they need, and the sources of information likely to be credible to the target audience.
• Use orientation sessions, seminars, lectures, and expert videos to address stakeholder concerns, particularly those of the clinical leaders implementing the program.

• Determine the core stakeholder team’s governance model and decision-making rights.
• Establish commitment and gain alignment from the leadership team regarding their expected roles and responsibilities.
• Establish feedback mechanisms, frequency, and modes of communication, including a reporting structure and schedule.

• Review key components of the program proposal or model and invite feedback, suggested iterations, and potential pitfalls. This review will make the program model more resilient and help to gain stakeholder buy-in.
• Make clear the accountabilities and responsibilities of the core stakeholder team regarding planning, implementation, and monitoring and evaluation of the proposed program.

• Draft a budget proposal based on the required resources.
• Ensure your funding and resource proposal considers the timeline of your program including what is required for initiation, implementation, and sustainability.
• Ask for feedback from different areas of your organization to identify any gaps.

• Refer to the potential stakeholders you identified from Goal 1 to help indicate where funding and resources might come from.
• Identify existing resources (e.g., human, physical space, technology, equipment, funding) that can be allocated for the program.
• Identify potential sources of funding for the different components of the program (e.g., government funding, private donations, existing reimbursement mechanisms).
• If applicable, prepare grant applications or set meetings with potential external funders.

• Identify who in your institution makes decisions about internal resources and set meetings to make your case and find alignment.

• A problem statement that is concise, specific, measurable, relevant and timebound, using the SMART goal framework;
• The objective, goals, and vision for the program;
• The target patient population (e.g., age, location, community) and why they should be prioritized for early detection;
• The scale of the early detection program (e.g., local, regional, or national, and how many clinics you intend to involve);
• A proposed program team, outlining the required roles;
• How your program will integrate with other programs in your setting, such as chronic disease management and elderly care, or other brain health programs; and,
• Your proposed program model and the essential functions of the program. Depending on your context, you may consider models such as Theory of Change, Driver Model.

What model does your healthcare system follow?

• Beveridge Model: Healthcare services are both paid for and provided by the government, free at point of service, and financed through taxation (e.g., United Kingdom, New Zealand, Spain, U.S. Veterans Health Administration).
• Bismarck Model: Healthcare paid for by non-profit insurance firms and provided by public and private actors, financed by employees and employers, generally through payroll deductions; often complemented by general tax revenues (e.g., Germany, France, Netherlands, Japan, Switzerland).
• National Health Insurance Single-Payer Model: Healthcare paid for by government-run insurance programs and provided by public and private actors, financed through taxation (e.g., Canada [at a provincial level], South Korea, U.S. Medicare).
• Out-of-pocket: Healthcare paid for by consumers to public and private care providers, little to no insurance coverage(e.g., rural regions of Africa, India, China, and South America). ^{9 10}

Note: U.S. healthcare incorporates aspects from all four models, resulting in a fragmented and variable system that offers different types of care and coverage to the population.¹¹

Policies and funding

• Are there existent policies (national, regional, local, and/or organizational) and funding structures in place for cognitive impairment detection and care?
• How much government (national, regional, local) involvement will there be in your program? Are there government approvals you’ll need to move forward with your program? How much interaction is there between your healthcare system and governmental bodies?

Existing programs or initiatives

• In your healthcare system or surrounding community, are there existing programs or efforts around brain health, elder care, or detection and care for cognitive impairment? (E.g., standards of practice, communities of practice, local Alzheimer’s disease organizations, elderly care programs?)

Stakeholders

• Who are the key internal and external stakeholders and what are their areas of interest for an early detection of cognitive impairment program? (E.g., government members, funders, advocates, vendors, healthcare providers, etc.)

Some additional questions to answer in determining your starting point are as follows:

• Can you collaborate or integrate with existing programs or organizations?
• How does your early detection program align with existing policies?
• If applicable, what sort of business model your early detection program might use?