Facilitating organisational change: The Hunter New England Health Smoke-free story
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Transcript of Facilitating organisational change: The Hunter New England Health Smoke-free story
Our vision: Healthier communities, Excellence in healthcareOur values: Teamwork, Honesty, Respect, Ethical, Excellence, Caring, Commitment, Courage
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
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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
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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.
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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
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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
2. 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
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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
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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)
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Results
71 71
8791
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Informed of SF Policy Recorded smoking status
Pro
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f Pa
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post
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Results Cont’d
4551
8492
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10
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90
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Assessed NicotineDependence
Offered NRT
Pro
po
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f Pa
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post
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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
Future Steps
• Succession plan
• Sustainable monitoring tool and system to facilitate sustainability of provision of smoking cessation care
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Key Messages
Leadership required
– Top down
– Bottom up
Consultation
Tailored support
Problem solve on a daily basis
Be available!
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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.