The need for setting up an Antimicrobial Stewardship Program or ASP for short is completed from a clinical perspective. But how do you make a business case for the program to the hospital leadership? What are some of the things you need to keep in mind when proposing a new program? We'll talk about some of these issues. Start by recognizing that the ASP proposal is going to compete with other projects for two things: one, resources to build an infrastructure, and two, attention of the clinicians who're being asked to do many other things. Now both of these require buy-in from the senior leaders who are setting the priorities and are allocating resources. So what are some of the things you need to keep in mind as you work on your ASP proposal? Start by learning what the priorities are for the hospital or the system. A typical hospital will have 20 to 30, sometimes more, improvement initiatives in any given year with five or so listed as strategic priorities. These can be clinical, operational, or financial priorities. Learn what these initiatives and parties are and recognize that the stewardship program will compete with these, for both resources and attention. This should give you some important context as you shape your proposal. The second thing you should do is learn how decisions are made. The hospital leaders want to do the right thing, so help them understand what you're proposing in terms that allow comparisons across projects that are competing for their attention. Most senior leaders make decisions based on at least four things. One, the importance and the relevance of the proposed program. Two, the strategic priorities. The investment thus needed and the investment could be in staff, it could be in IT resources. What the return on investment is, which could again be financial, operational, or clinical, or ideally all three, and their confidence in the ability of the team to execute. Now, this is one of the intangibles, but it's an important factor that goes into their decision. The third recommendation is to make your ASP proposal crisp. I suggest framing it as a value improvement initiative. Frame how the program will improve quality and lower costs, that's the value proposition. Include goals and metrics that are clear and achievable over short time horizon. Not just five or ten year plan, but what are you targeting to achieve in the first year, in the second year and so on? Now, as you're setting goals, reducing emergence of drug resistant organisms is certainly an important goal clinically, but it's hard to translate this goal or quantify it. Instead, lists the antimicrobials that you'll be targeting, what their baseline use is and what the target for improvement is. Now one caveat, you should remind them that the goal is appropriate to use, not just reduction in use of antimicrobials. Including baseline cost and a dollar opportunity will provide a clear reference as they look at the ROI. Citing benchmarks and best practices will make the case stronger for the resources you're asking for. Now, if these investments that you are asking for will not be fully offset by the direct cost savings, it's important to highlight the other tangible benefits, such as improvement in patient outcomes, and patient experience from lower C. difficile rates. Next, list any regulatory compliance standards, for example, the Joint Commission or the CDC and any impact that the initiatives will have on value-based purchasing payments or on publicly reported measures. Keep in mind that C. difficile rates are part of the Medicare hospital-acquired conditions or HAC penalty calculations. Show how you will coordinate with or even better, how you will add to existing improvement efforts. For example, compliance with the sepsis bundle, which is a core measure and improvement in substance survival rates by supporting timely and appropriate antibiotics, and ensuring an antibiotic timeout. Now if you can, highlight any prior accomplishments of the team and progress that may already be made especially if you've had a pilot program. That can be really useful in making a case that the team is likely to execute on the program. The fourth component is implementation and monitoring. If the investment required is sizable, it's better to propose a phased implementation, which can help you get the resources in increments as the program achieves targets perhaps, year by year. Most hospital leaders will see this as a demonstration of faith partnership rather than a quid pro quo transaction of resources. Now it is important that once the resources are committed and the program is established that you provide regular updates on progress using the metrics you've established for the program as part of your proposal. As the program develops, there's a good chance that you will have to go back for additional resources. Having an accountable metric based relationship will help the next conversation. Thank you, and good luck.