Strategy: Establish accountability mechanisms

Collecting and using data drives practice change

Using data, information and systems to support the delivery of clinical services can significantly improve health service practice. Experiences in smoking cessation interventions suggest that the use of data collection tools and feedback processes can increase the frequency and effectiveness of smoking cessation interventions in hospitals and health services.1,2

Further, electronic records and systems are effective in improving the quantity and quality of evidence-based smoking cessation interventions in hospitals, including systems that:

  • record smoking status
  • provide clinical supports, prompts and reminders for nicotine replacement therapy (NRT) dosage and treatment pathways
  • prompt for referral and follow-up to smoking cessation support.

Data can be used to develop formal accountabilities

Experience from successful smoke-free health policies and programs have shown that the use of contractual arrangements (or service level agreements) that mandate the provision of smoking cessation interventions (often through a key performance indicator) is an effective implementation strategy.

Such arrangements can occur as part of individual service level agreements between a statewide funding body to a local health district (LHD); as well as between an LHD executive and individual service, such as community nursing or a hospital.

Electronic data collection

Incorporate data about the provision of (and reminders for) smoking cessation care into electronic patient records, electronic health systems and clinical data systems, where possible.

In the absence of electronic processes, include this information in paper records.

This addresses other Framework strategies, such as supporting staff and establishing accountability, as well as providing evidence to strengthen leadership.

Suggested actions

Implement a system for identifying patients and clients who smoke and documenting smoking status in every clinic and hospital.
Ensure clinical data systems include relevant prompts, reminders, tools and templates, decision support systems and facilitate referral and follow-up.
Ensure electronic health records and systems facilitate the recording of necessary information to monitor performance and provide for auditing and reporting.

This includes being able to access information on the documentation of smoking status, levels of nicotine dependence, provision of counselling, prescription of NRT and appropriate follow-up.
In the absence of data systems, implement processes that collect the necessary information to monitor performance and provide for auditing and reporting, including:
  • information on a patient or client’s smoking status
  • assessment of their levels of nicotine dependence
  • notes on what counselling has occurred
  • what NRT and follow-up has been provided.
Recommend inclusion of smoking cessation key performance indicators within service agreements between the Ministry of Health and LHDs.
Initiate internal service level agreements (or similar) with individual LHD units or hospitals that include smoking cessation key performance indicators and targets, where appropriate.


  1. Boyle R, Solberg L, Fiore M. Use of electronic health records to support smoking cessation. Cochrane Database Syst Rev 2011;12:CD008743.
  2. Kisuule F, Necochea A, Howe EE, Wright S. Utilizing audit and feedback to improve hospitalists’ performance in tobacco dependence counseling. Nicotine & tobacco research 2010;12(8):797-800.