Encouraging Action on Smoking-cessation Programs in Ontario Hospitals

In January, the McMaster Health Forum convened a Stakeholder Dialogue titled Expanding the Uptake of Hospital-based Tobacco-use Cessation Supports. Both the dialogue and an evidence brief that was prepared to inform it were funded by the Ontario Ministry of Health and Long-Term Care. The event brought together a diverse group of stakeholders that included two policymakers, 11 managers and executives from a wide range of settings, four individuals involved in leading tobacco cessation efforts, and three researchers. As a member of the dialogue secretariat, I had the opportunity to observe while participants deliberated about the issue, critically examined possible solutions, and decided on the next steps for action.

For anyone unfamiliar with stakeholder dialogues, they are the McMaster Health Forum’s signature events. Stakeholder dialogues bring together influential thinkers and doers from a variety of backgrounds who are knowledgeable about a particular health issue, and bring with them a wealth of experience and insights to inform a full day of discussions. The dialogues (informed by the pre-circulated evidence brief) are facilitated by Forum Director John Lavis, who is an expert in knowledge transfer and exchange in public policymaking environments. The dialogues involve months of careful planning by Forum staff as well as numerous consultations with a steering committee that helps in deciding everything from who’s invited to what’s contained in the pre- and post-dialogue materials.

This particular dialogue focused on developing a strategy to expand tobacco-use cessation programs in Ontario hospitals.

The Issue

Currently, Ontario hospitals lack a standard model for identifying, advising and providing on-going support to smokers, resulting in considerable variation in the quality of care offered. Hospital stays offer health care providers a prime opportunity to initiate smoking cessation because patients are exposed to a smoke-free environment, and quitting often aids in their recovery. However, despite being well-positioned to initiate such programs and encourage positive lifestyle changes, tobacco-cessation efforts are typically not on hospital boards’ priority lists. In discussing why this is the case, one participant stated frankly that “hospitals simply aren’t in the business of prevention”, by which he was referring to the fact that many hospital boards view smoking cessation as being the responsibility of public health officials. This prevailing view, along with other factors such as resource constraints, result in hospitals being either unwilling or unable to deliver effective cessation programs for smokers.

The dialogue began with brief introductions from the participants, then moved onto defining the problem and brainstorming ways to frame it as a critical issue in getting hospital boards on board. Participants identified a clear need to raise awareness about smoking-cessation programs and their positive impact on patient recovery by communicating these benefits in a way that fits with the priorities of hospital boards and other important stakeholders. For example, one participant suggested compiling data on the impact of tobacco-cessation programs on hospital readmission rates, and another recommended looking at their impact on patient recovery from other illnesses that are often complicated by tobacco use. And it’s not just hospitals that need to be targeted, but a host of other organizations such as Local Health Integration Networks (LHINs), community access centres, training colleges and accrediting bodies. If tobacco-use cessation programs are to be adopted, they need to be mandated by the institutions that hospitals are accountable to — namely those that provide them with funding and accreditation.

As an undergraduate student who was unfamiliar with the topic, I was pleasantly surprised by the connections I was able to make between the dialogue discussion and materials I’ve learned in classes. In my Global Health Advocacy course, we focus a lot on analysing how issues are framed to appeal to important decision-makers in order to influence perceptions and outcomes. We’ve learned that some frames are more effective than others: some demand urgent action, while others are in-line with important goals of the key actors who have the power to enact change. A large part of this stakeholder dialogue was an exercise in framing — it was about first identifying the important decision-makers who had the political power and resources, and then deciding on the best way to get the issue of hospital-based tobacco-use cessation programs onto the agendas of those important decision-makers. In deciding on the best approach, there was constant emphasis on using the best available evidence. But it wasn’t just about the numbers — many of the participants had first-hand experience delivering tobacco-cessation programs and had personally dealt with patients who were struggling to quit. The wealth of personal experience with patients not only informed the discussions, but also reinforced the need to take action. I was moved by the emotion with which some of the participants spoke, and their genuine concern for the welfare of patients. Because of the strict observance of Chatham House rules that allow participants to use information received during the meeting as long as neither the speaker’s identity nor his or her affiliation is revealed, many participants felt comfortable being frank in their discussions.

Overall, I thought the dialogue was very constructive: it addressed the key problems surrounding the implementation of an Ontario-wide hospital-based tobacco-cessation program. With Lavis’s skillful facilitation, it accomplished the tough job of devising a concrete plan of action to fully address the issue and its implementation. Even more importantly, it got key players talking about the issue. I was pleased to see so many of the participants engaged in animated discussion during their lunch break and after the dialogue ended. These individuals will hopefully bring back to their organizations the insights gained during the dialogue and use them to take action to effectively address the challenge.

For a more detailed look at the goals and outcomes of the dialogue and for more information about expanding the uptake of hospital-based tobacco-use cessation supports, check out the topic overview, evidence brief and dialogue summary. Many of the participants also took part in interviews after the dialogue, briefly discussing the insights gained from the dialogue and what next steps they plan to take. They are available as video or audio files.

By: Piyumi Galappatti, Research Assistant

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