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

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Facilitating organisational change: The Hunter New England Health Smoke-free story. Prepared by: Carolyn Slattery, Rebecca Wyse, Jenny Knight, Inga Kasch, Lorraine Paras, Megan Freund HUNTER NEW ENGLAND POPULATION HEALTH 5 September 2007. Background. NSW Health directive to go Smoke-free - PowerPoint PPT Presentation

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  • BackgroundNSW Health directive to go Smoke-freeMarch 2006 Hunter New England (HNE) set smoke free dateHistory in HNE of smoking cessation pilot programsOrganisational change requiredHNE Health went Smoke-free on October 31st 2006 Vision to Reality..in 8 months

    Centre - "Procedures" very vague what do we mean by this?

  • What did we want to achieveNSW Health mandates a comprehensive approach to implementing a Smoke Free Health Service Policy:Patient supportStaff cessation supportEnforcementCommunicationFocus of presentation is:Inpatient smoking care across all HNE facilities.

  • The Challenges ChallengesLarge area (130,000 sq km)Large no of facilities (54)15 000 staffDiversity rural/remote/metroLimited resourcesNo existing area-wide procedures

    Base located here

  • Method - Intervention 1.Local consensus Inpatient working group formed and:Identified key smoking care practicesDeveloped a clinical practice guidelineIdentified recording requirements Developed Nurse Initiated Medication Protocol NRTSystems changeNicotine dependent care assessment formIncident Information Management System (IIMS)Supply of 3 day post discharge medication3.Training/skill development2 nurse train the trainer sessions delivered Multiple planned telephone contacts with Nurse Unit Managers (NUM) and Senior Nurse Mangers (SNM)Medical officers information sheet

  • Method Intervention contd4.CommunicationStaff eg staff newsletter, information sheets, websitePatient eg brochures, posters, Media, informed of the policy on admission5.Prompts NUM and SNM contacted for compliance with implementation protocols6.Management supportTelephone contact with NUMs and SNMsSmoke-free email7.Monitoring compliance and feedback4 x Telephone contacts with NUMs Area wide bedside auditResults of above feed back to wards and Nurse ManagementSNMs and NUMs provided Smoke Free team feedback

  • Method Pre - Post test designCare provision data collected from NUMsEligibility criteriaWards with smokers admitted since Oct 31st completed both (pre & post) telephone contactsMeasures: % patients informed about SF policy% smokers recorded as smokers% smokers who had nicotine dependence assessed% nicotine dependent smokers offered NRTResponse rate 100% (n=67)

    Centre - Modify according to what goes on earlier -i.e. "both"

  • Results

  • Results Contd

  • SummaryLarge improvement in smoking cessation care across HNE facilitiesDuplication 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 analysedIntervention provides a feasible and effective way for facilitating change across a large, diverse area Future StepsSuccession planSustainable monitoring tool and system to facilitate sustainability of provision of smoking cessation care

  • Key MessagesLeadership requiredTop down Bottom upConsultationTailored supportProblem solve on a daily basisBe available!

  • AcknowledgementsWith grateful acknowledgements of:Jenny Knight, Rebecca WyseSue GreenChristophe Lecathelinais, Lynn Francis, CATI interviewersBev Parker Jenny JacksonOlga PeersHunter 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.

    INTRO:My name is and Im from My presentation today is about how we HNE Health went Smoke-free on October 31st 2006 There was a directive from NSW Health which required Area Health Services to go totally smoke-free which meant that there was to be no smoking anywhere on hospital grounds, include buildings, carparks, outdoor areas etc

    February 2006 HNE set smoke free dateIn February 2006 the Executive of HNE identified a smoke free date this gave us 8 months to prepare to go smoke free

    As HNE had a history of smoking cessation pilot programs we were are of the importance of organisational change if we were going to change care practice in HNE facilities.

    HNE Health went Smoke-free on October 31st 2006

    How did this all come about?. The Hunter New England

    What we needed to do In order to successfully implement this policy we needed to develop and implement an Area-wide strategy for organisational change. We knew ( from capacity building organisational change literature) that a collaborative, top-down approach would be most suitable The strategy would need to ensure that - patients were supported not to smoke onsite - clinical staff were provided with resources and training to support patientsHunter New England went smoke-free on October 31st 2006*

    What did we want to achieve

    To increase the provision of appropriate smoking cessation care across HNE facilities.Organisation change was required to ensure increased provision of smoking cessation care across HNE facilities.

    However, facilitating organisation change was going to be a challenge.

    Some of the challenges being:Large area - 130,000 sq km (size of England)Diversity: eg Metropolitian hospitals of 550 beds to small, small community hospital of 10 beds We needed to bring about across: - 54 Facilities, 93 inpatient wardsLimited resources (0.8 FTE Program Manager, 1.6 FTE Project Officers)Limited area wide systemsEg No standard admission recording practicesNo existing area wide proceduresEg No protocols for providing cessation care (e.g. NRT)

    Method intervention

    How did we meet the challenges

    Local consensus Inpatient working group formed there were representatives from all levels of clinical structure and from different facilities across the area.The inpatient working group: Identified key smoking care practices (assessment, brief advice and referral)Developed clinical practice guideline for managing inpatient who smoke (based on NSW Health guideline managing ND inpatients)Identified recording requirements basis of Nicotine Dependent Care assessment form Developed Nurse Initiated Medication Protocol NRT

    Training/skill development2 train the trainer sessions deliveredTraining package emailed and posted on intranetMedical officers information sheet disseminated

    Reinforcing strategiesPrompts and incentivesPerformance feedbackOrganisational change to achieve population health outcomes lends itself to the application of the multi-strategic, sustainability driven, capacity building framework. The variation in stages of awareness, of the potential to reduce alcohol related crime within Police, demanded that the capacity building framework was applied in a manner that was sensitive to the stage of change of the targeted part of the organization. A multi-strategic plan was needed to ensure that change would be embedded in the organization and remain effective after the time frame of the initial funding.Organisational Capacity Building FrameworkCapacity Building frameworks suggest planning around the organisational components ofLeadershipWorkforce developmentResource allocationOrganisational Infrastructure ( IT / policies / procedures / performance monitoring).

    3. Monitoring compliance and feedback4 x Telephone contacts with Nursing Unit Managers (NUM) Area wide bedside auditResults of above feed back to wards and management4.Prompts Area wide nicotine dependent care assessment form prompts the provision of careTelephone contacts with NUMs and Senior Nurse Mangers (SNM) prompt to ensure procedures in place5.Management supportTelephone contact with NUMs and SNMs - how they can delivery trainingSmoke-free email6.CommunicationStaff eg The latest, information sheets, websitePatient eg brochures, posters, Media, informed of the policy on admission

    Pre - Post testNurse unit managers self-report telephone contactBaseline measures: % patients informed about SF policy% smokers recorded as smokers% smokers who had nicotine dependence assessed% nicotine dependent smokers offered NRTResponse rate 100%Pre post samplehad had smokers admitted since Oct 31st completed both (pre & post) telephone contacts

    Discussion

    Large improvement in smoking cessation care across HNE facilitiesResults similar to other studies that have been highly resourced at a small number of facilitiesIntervention provides a feasible and effective way for facilitating change across a large, diverse area TipsProblem solving every dayBe availablePolicy DirectiveFuture Identification of a sustain monitoring tool and system to facilitate sustainability of provision of smoking cessation care