Facilitating organisational change: The Hunter New England Health Smoke-free story

1. Facilitating organisational change: The Hunter New England Health Smoke-free story Prepared by: Carolyn Slattery, Rebecca Wyse, Jenny Knight, Inga Kasch, Lorraine Paras, Megan FreundHUNTER NEW ENGLAND POPULATION HEALTH 5 September 2007

2. Background • NSW Health directive to go Smoke-free • March 2006 Hunter New England (HNE) set smoke free date • History in HNE of smoking cessation pilot programs • Organisational change required • HNE Health went Smoke-free on October 31st 2006 Vision to Reality……..in 8 months

3. What did we want to achieve • NSW Health mandates a comprehensive approach to implementing a Smoke Free Health Service Policy: • Patient support • Staff cessation support • Enforcement • Communication • Focus of presentation is: • Inpatient smoking care across all HNE facilities.

4. The Challenges … • Challenges • Large area (130,000 sq km) • Large no of facilities (54) • 15 000 staff • Diversity – rural/remote/metro • Limited resources • No existing area-wide procedures Base located here

5. Method - Intervention 1. Local consensus Inpatient working group formed and: • Identified key smoking care practices • Developed a clinical practice guideline • Identified recording requirements • Developed Nurse Initiated Medication Protocol – NRT • Systems change • Nicotine dependent care assessment form • Incident Information Management System (IIMS) • Supply of 3 day post discharge medication 3.Training/skill development • 2 nurse train the trainer sessions delivered • Multiple planned telephone contacts with Nurse Unit Manager’s (NUM) and Senior Nurse Mangers (SNM) • Medical officer’s information sheet

6. Method – Intervention cont’d 4. Communication • Staff eg staff newsletter, information sheets, website • Patient eg brochures, posters, Media, informed of the policy on admission 5. Prompts • NUM and SNM contacted for compliance with implementation protocols 6.Management support • Telephone contact with NUM’s and SNM’s • Smoke-free email 7. Monitoring compliance and feedback • 4 x Telephone contacts with NUM’s • Area wide bedside audit • Results of above feed back to wards and Nurse Management • SNM’s and NUM’s provided Smoke Free team feedback

7. Method • Pre - Post test design • Care provision data collected from NUMs • Eligibility criteria • Wards with smokers admitted since Oct 31st • completed both (pre & post) telephone contacts • Measures: • % patients informed about SF policy • % smokers recorded as smokers • % smokers who had nicotine dependence assessed • % nicotine dependent smokers offered NRT • Response rate 100% (n=67)

8. Results

9. Results Cont’d

10. Summary • Large improvement in smoking cessation care across HNE facilities • Duplication of single facility results across a large Area Health Service (ie all patients in multiple facilities). • Validation data of self report from bed side audits currently being analysed • Intervention provides a feasible and effective way for facilitating change across a large, diverse area • FutureSteps • Succession plan • Sustainable monitoring tool and system to facilitate sustainability of provision of smoking cessation care

11. Key Messages • Leadership required • Top down • Bottom up • Consultation • Tailored support • Problem solve on a daily basis • Be available!

12. Acknowledgements • With grateful acknowledgements of: • Jenny Knight, • Rebecca Wyse • Sue Green • Christophe Lecathelinais, • Lynn Francis, • CATI interviewers • Bev Parker • Jenny Jackson • Olga Peers Hunter New England Population Health is a unit of the Hunter New England Area Health Service. Supported by funding from NSW Health through the Hunter Medical Research Institute. Developed in partnership with the University of Newcastle.