Once the preceding 3 major elements are understood and a group decides to move ahead with introduction of regional anesthesia or expansion of regional anesthesia into its practice, strategies need to be developed to optimize this introduction. First, a core group of regional anesthesia physicians who agree, in principle, on the plan must be established. It is most effective if, as a system is rolled out, a small number of surgeons and surgical procedures are used as the initial clinical settings so that "success" can be validated more quickly. One of the easiest ways to cause an introduction of regional anesthesia to a practice to fail is to try to be all things to all patients and all surgeons at the outset. It is important to emphasize that successful introduction of regional anesthesia to a practice demands that all involved perceive that regional anesthesia is truly an advantage to the patient, to the surgeon, to the anesthesiologist, and to the institution. Collins et al14 provided clear evidence for this as they examined the impact of a regional anesthesia–analgesia program for outpatient foot surgery. They documented a marked increase in regional anesthesia use, no decrease in operating room efficiency, reduced postanesthesia care unit and discharge time, decreased analgesic use, and decreased nursing interventions for analgesia.