Lessons learned from implementing the PHS Tobacco Guideline: Defining a practical Implementation Process Model with micro-level strategies for individual clinics

The U.S. Department of Health and Human Services, Office on Women's Health (OWH), convened Federal partners to implement the Public Health Service's Treating Tobacco Use and Dependence: 2008 Update (the Guideline) for women of childbearing age in underserved clinics. Initial project results identified practical steps and micro-level strategies to help improve success in Guideline implementation in individual clinics. OWH summarized the steps and strategies into an Implementation Process Model, which offers multiple practical details and examples that any clinic can use. The Guideline recommends interventions for tobacco cessation and discusses systems change strategies. Phase 1 of the OWH project implemented the Guideline in twenty Clinical Collaboratives from the Indian Health Service and Health Resources and Services Administration. Focus groups with provider and administrative clinical personnel identified lessons learned, including the need to establish a culture of tobacco awareness and cessation in individual clinics. To develop such a culture and ensure success in Guideline implementation, project participants had to address barriers and identify micro-level systems change strategies for their individual clinics. Derived from the lessons learned, the Model includes practical “how-to” information about: • Assessing current status; • Identifying champion/leader(s); • Planning data collection and evaluation; • Determining funding/reimbursement; • Formulating policies and internal links; • Establishing external linkages; • Providing training; • Delivering interventions; and • Assessing and evaluating the program.

Although the OWH project focused on underserved women, the Model can apply to an entire clinic, including all patients.