Key facilitators of tobacco cessation systems changes implementation in four Minnesota health systems

Issue: Health systems play a key role in identifying and treating tobacco use. Systems change – changing the processes for how health care is delivered – can build the capacity of health care systems by establishing sustainable, integrated solutions to address tobacco use. Description: Between 2010 and 2012, ClearWay Minnesota^sm piloted and evaluated a health systems change funding initiative that provided resources and technical assistance to four health systems that had previously provided direct cessation services. The health systems serve varying urban and rural patient populations across Minnesota. Systems change strategies included implementing new tobacco cessation screening, brief intervention and referral protocols, providing training to staff and providers, and making modifications to electronic medical record systems. Lessons Learned: Key facilitators of systems changes included capitalizing on changes in the environment (internal or external to the system); ensuring participation, buy-in, and support at all levels within the health system; utilizing technology to support process improvement; and establishing on-going training and monitoring mechanisms. Additionally, external funding for these efforts elevated the importance of implementing tobacco treatment-related systems changes. Recommendations: Public health funding entities (public or private) and health systems may wish to consider similar approaches to facilitate sustainable integration of tobacco treatment within health systems in order to reduce healthcare costs associated with tobacco-related illness and systematically impact rates of tobacco use.