accountable for the implementation and maintenance processes [13]. It is essential to dene leaders and assemble a multidisciplinary team, identifying champions from all involved specialties that will take the lead in organizing, implementing, and maintaining their specialty’s respective roles in the ERP. The team begins with dening a local clinical champion, who recognizes its benets. This individual then forms a working group of similar-minded individuals from all involved parties into a steering committee, which should be able to effectively disseminate the clinical and economic benets of the ERP approach to their colleagues, implement, and monitor changes. This steering committee should consist of representatives from the involved specialties, as well as allied health professionals that are essential for patient care. This multidisciplinary team is recommended to include surgeons, anes­thesiologists, internists, nursing representatives from the preoperative center, post­anesthesia care unit, surgical ward, physiotherapists, pharmacists, and nutritionists that meet on a regular schedule. Each of these individuals represents an essential component in the patient’s perioperative journey. The role of the surgeon and anes­thesiologist is obvious; however other specialties and team members should also be recruited. For example, much of the preoperative testing and evaluation can be streamlined to minimize patient burden and resource utilization. In this regard, the inclusion of a representative of the medical specialty in charge of preoperative cen­ter is crucial. Operating room, perioperative care, and ward nursing representation are also critical, to ensure education, acceptance, and compliance with the ERP items during surgery and the patient’s stay in the postanesthesia recovery unit and inpatient oor. Similarly, allied health professionals that provide much of the care processes in the perioperative period should also be included. Pharmacists are an essential team member for agreement with medications included in the pathways and ease of future clinical trials. Nutrition, physical therapy, and wound ostomy care nurses are invaluable for input on managing high-risk and frail patients during the prehabilitation and postoperative periods. In most hospital systems, trainees are actively involved in patient care and may actually have the primary role of putting in orders and patient education. Thus, surgical resident involvement for ownership and buy-in of the care practices by the house staff is critical. For centers with the means or desire to publish, a librarian who can provide detailed literature searches on the best available evidence can also facilitate the dissemination process and path­way design. Once protocols have been developed and approved, the Information Technologies department can help streamline the implementation and audit pro­cesses, by integrating the pathways into the electronic medical record with auto­mated order sets, back-end databases, and personalized queries on outcomes metrics. Finally, a dedicated ERP facilitator is one of the essential elements com­monly overlooked. The facilitator is paramount for successful ERP implementation and subsequent audit processes [14, 15]. The ERP facilitator is mostly a nurse, nurse practitioner, or physician assistant (most common in the United States). Their responsibilities include reviewing the literature and evidence-based guidelines; shepherding the pathways through the approval process; maintaining momentum; creating patient education material; coordinating education sessions, meetings, and launch; and, nally, conducting postlaunch feedback and audit [15]. In cases where

allied health staff, assure presentations occur at multiple periods to include staff that work on evening or weekend shifts. With education, acceptance of the culture change will come, followed by willing participation and then nally excitement for the new standard and identication of ERP champions. It is especially important to educate the primary caretakers, including nursing and other allied health professionals in the preoperative clinic, postanesthesia care unit, and postoperative surgical ward, as ERPs may require signicant departures from long-standing practices. Specic changes like removing patient-controlled analgesia (PCAs) after surgery and remov­ing the practice of preoperative fasting starting at midnight the night before surgery require changes across multiple providers, preoperative clinic, admitting ofce, pre­anesthesia clinic and anesthesiologists, and postoperative and ward nursing. These changes can be facilitated with the support of the champions, who can effectively set goals, disseminate the evidence and benets underlying the proposed changes, and support the implementation [1].