*5.4. Leadership*

The purveyor must be in control and has to relinquish control. The purveyor (in this case, Robin McWilliam) has to be the arbiter of what constitutes fidelity to the model [57]. The purveyor has to protect and promote this fidelity for two reasons. One is that any evidence on which the model is based involved specific practices, so deviation can render the practice no longer evidence based. The second reason is a branding and credibility one: If people are saying they are using a model or its practices, when in fact they are not, any success or failure of their efforts will not really reflect the model.

Local leadership is the key [58]. In every successful implementation of the RBM, one or more local leaders have gone through the stages of implementation to explore options, decide on the RBM as a solution to needs they saw, shepherded the initial implementation, and planned for full implementation. Some of our sites are well into implementation and others are near the beginning, but the role of key players, many of whom are authors of this article, cannot be underestimated.

Because this model was developed in the U.S., one might think the implementation over the past 15 years has been one way. Actually, as we have mentioned a number of times, to make it truly a global model, we have had to make modifications. Implementers from different countries have learned from each other. For example, Marisú Pedernera, the bright young linchpin for the Paraguayan implementation, corresponds with a colleague in Taiwan, with Cami Stevenson in Portland, Oregon, and with colleagues in Spain. Many implementers and other international professionals interested

in the RBM are members of The RAM Group, a community of practice dedicated to the exchange of information about the model (www.ramgroup.info).
