# Perspectives on Clinical Champions Implementing Hospital-Based Opioid Treatment in US Hospitals

## TL;DR

This study identifies key traits and supports for hospital staff who successfully implement opioid treatment programs in US hospitals.

## Contribution

The study reveals that effective clinical champions are respected insiders with persistence and systems change skills, supported by leadership and external resources.

## Key findings

- Effective champions are respected insiders with institutional influence and systems change skills.
- Champions successfully embed HBOT into workflows using patient narratives and multidisciplinary teams.
- Leadership support, protected time, and external facilitation are critical for champion success.

## Abstract

This qualitative study evaluates characteristics and supports of effective clinical champions implementing hospital-based opioid treatment in US hospitals.

What characteristics and supports enable effective champions to implement hospital-based opioid treatment (HBOT) in US hospitals?

In this qualitative study of 31 hospital staff across 12 community hospitals, effective champions were perceived as respected insiders with institutional influence, persistence, and systems change skills. They built multidisciplinary teams, embedded HBOT into workflows, and overcame barriers through patient narratives. Champions were seen as most effective when supported by executive leadership, protected time, and external practice facilitation.

To expand HBOT, these findings suggest hospitals should invest in influential champions and provide leadership support, dedicated time, and external resources that can accelerate adoption of evidence-based addiction care.

Hospital-based opioid treatment (HBOT) can improve outcomes for patients with opioid use disorder, but little is known about specific attributes and supports needed for clinical champions to successfully implement HBOT.

To identify characteristics and supports of effective clinical champions implementing HBOT in US hospitals.

Qualitative study using postimplementation semistructured interviews conducted with individuals highly involved in HBOT implementation, including champions and hospital staff at 12 US community hospitals randomized to the high-intensity group of the Exemplar Hospital Initiation Trial to Enhance Treatment Engagement, a national implementation trial comparing low- and high-intensity HBOT implementation strategies. Interviews explored implementation experiences over 24 months from December 2021 to December 2023. Interviews were audio recorded, transcribed, and coded. The framework method and in-depth thematic analysis were used to explore the role of champions.

All hospitals received a best-practices manual, video webinar series, and hub team support for questions, while hospitals randomized to the high-intensity group also received monthly practice facilitation, telementoring, and 10% effort funding for a local champion. Champions led HBOT implementation with support from regional hubs with HBOT expertise.

Effective champions were defined as those perceived by staff to successfully lead HBOT implementation. Open-ended questions and thematic analysis explored participants’ perspectives on attributes of effective champions and how they overcame implementation barriers.

A total of 31 hospital staff (15 physicians, 5 executives, 5 pharmacists, 2 nurse practitioners, 2 social workers, 1 nurse, and 1 addiction counselor) were interviewed. Effective champions were perceived as respected hospital “insiders” with institutional influence, persistence, and systems change skills. They built multidisciplinary teams, developed standard workflows, and used emotionally resonant strategies (eg, patient narratives) to overcome stigma and engage hospital leadership. Champions could be effective without addiction medicine expertise, particularly when provided with protected time, hospital leadership support, and external practice facilitation from addiction experts.

This multisite qualitative study underscores the vital role of champions in expanding hospital-based opioid care. To ensure HBOT expansion, hospitals should invest in champions, protected time, leadership backing, and external supports that legitimize and routinize evidence-based addiction care.