This Quick Start Guide provides seven evidence-based steps and 10 tools & resources to improve tobacco cessation services using Quality Improvement (QI) methods. The modular format enables users to select tips and tools that are most relevant to their practice.
Use this Guide as a first step to reduce tobacco use among your patients. Whether you are in an administrative, clinical, health promotion, or leadership role, these materials can assist with developing a tobacco cessation plan, engaging colleagues, and adapting workflows to systematize cessation, increasing effectiveness and efficiency.
1. Start with "Why"
If you want to improve tobacco cessation in your primary care setting, think carefully about why. Perhaps you view improving cessation as a health equity issue. Or, maybe you are concerned with the targeting of youth by the tobacco industry and its worrisome stream of new nicotine products. Whatever your vision as to why cessation is important, be clear and compelling so that you can inspire others to join you in striving for this vision.
Author Simon Sinek presented a TED Talk entitled, “How Great Leaders Inspire Action,” that has been viewed more than 68 million times. In the presentation, Sinek proposes that great leaders inspire action by presenting a vision that people can feel and believe in. For example, he proposes that Martin Luther King was one of the great leaders of the civil rights movement in the U.S. because he helped many Americans to believe themselves, in his dream of a country based on equality and justice. This belief that a better America was possible was the driver for why the civil rights movement was important. The demonstrations, advocacy, and policy change constituted the how and what of the movement.
"My hope is to help other people...I’d tell them it’s not worth it to smoke. Their lives and their health are worth more."—Angie, Former Smoker
2. Identify Program Champions
Program champions are individuals that share a common vision and who are willing to invest time and energy to support a program that advances that vision. Since improving tobacco cessation in the primary care setting is a complex undertaking, it is best addressed as a Quality Improvement (QI) program. It will require a multi-disciplinary team that understands and has some experience with:
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Clinical Guidelines and workflow.
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Electronic Health Records (EHR).
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QI methods including data collection and analysis: budgeting and resources allocation.
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Training and project management.
Given this complexity, identifying one or more program champions, in addition to yourself, is an important early step. Champions may be found in clinical, administrative, health promotion, and leadership roles, throughout your organization.
3. Build a Team
Once you have identified and recruited one or more program champions as described in Section 2, you can work together to begin building a program team. It will take time to build a complete QI team, depending on the organization’s interest, available resources, and other factors. Once you have two or more program champions, you have an initial team and you can begin planning.
4. Develop a Plan
As mentioned in Step 2, improving tobacco cessation in a primary care setting is best achieved as a QI program. Such a program is guided by a Quality Improvement Plan (QIP). It is important to recruit a staff member (or retain a consultant) with QI expertise to support the development and management of a QIP. While the details of the QI process are beyond the scope of this web resource, we do offer a number of templates, patient and professional education materials, analytic resources, and practice tools that may be useful to your team as the QIP is developed.
5. Engage with Staff
As a draft QIP is being developed, staff engagement is an important first step. This process should include a presentation to all staff regarding the purpose, key elements, and timeline for implementation of the QI program, including discussion of an early draft of the QIP. Staff feedback should be used to enhance the QIP and to inform how staff support of the QI program can be fostered. As the QIP is being finalized, initial and ongoing staff briefings and trainings should be included as necessary plan components.
"Celebrate wins loudly. Highlighting even one successful quit builds momentum. Data matters but patient wins inspire and remind us why this work matters."—Tobacco Cessation Clinic Coordinator
6. Set the Stage
There are recommended elements in the physical and policy environment of a primary care clinic that support effective, clinic-based tobacco cessation. These elements include: proper anti-tobacco signage in the clinic and around the campus; health-promoting messaging encouraging cessation in waiting rooms and exam rooms; anti-tobacco policies supporting employee health, etc.
It is also important to think about clinic patients that may rarely attend clinic visits. Outreach programs using mailed information, phone calls, and social media can help to encourage cessation among patients that use tobacco.
7. Keep the Momentum
Since many individuals that use tobacco make 10-15 quit attempts before quitting for good, individual follow-up through texting, emails, or phone calls can be very effective at keeping the cessation process going, ultimately leading to successful quitting. In addition, from a system perspective, follow-up is very important to keep staff engaged with the program. Presentations at staff meetings, articles in clinic newsletters, training sessions, and other channels can be used to discuss program successes (e.g., case presentations of patients that have quit for good), challenges, and ways to improve the QI program on cessation.