Documenting Implementation Team Membership, Capacities, and Roles  

The team can use Template 2.1 (Appendix A) to track the relevant skills, knowledge, assets, and roles that team members bring to the organizational change process. Using such a template allows the team to identify “holes” in its membership and think about additional partners with particular skillsets that can aid implementation. The team can also modify this template to include others at the clinic who have a role to play in organizational change but may not be full-fledged members of the team. 

TEMPLATE 2.1 Documenting Implementation Team Membership, Capacities, and Roles 



Capacities (e.g., relevant skills, knowledge, and assets) 

Organizational change role and responsibilities

Date joined

Sam T.

Information technology specialist, and

team leader

Speaks Spanish. Led previous efforts to modify electronic health record (EHR) system.

Convene team meetings. Interface with EHR vendor about updates. Translate forms into Spanish.


Perla S.

Front desk clerk

Has strong relationships in the SGM community.

Train front desk staff to ask gender identity questions and respond to patient concerns.  Recruit community members for the SGM advisory board.


Sheila M.

Family practice physician

Fluent in Spanish. Has taken part in recent professional development related to gender-affirming care.

Organize professional development for providers.  Undertake Spanish translations of training materials.


Harris B.


Speaks Diné. Has experience reviewing and updating the clinic’s policies and procedures.

Assure all appropriate clinic protocols are followed. 


Emilio D.

Member of Board of Directors

Has strong relationships in the SGM community.

Interact with other board members and gain community support.