Strategy: Leadership and governance structures

Strong leadership is fundamentally important to successfully promoting clinical practice change

Evidence shows that endorsement, sponsorship and support from executives at jurisdiction and hospital levels is key to the successful implementation of smoking cessation interventions in health services.1

Leadership and formal endorsement of initiatives by Chief Executives and clinical leaders will ensure that developing smoking cessation interventions is a priority. This is important as health professionals face multiple competing demands.

Senior health professionals are also critical role models to inspire and encourage their peers to deliver quality patient care that addresses smoking as a significant health issue. Junior doctors and other clinical staff are more likely to address smoking when they see senior health professionals integrating smoking cessation into routine care.

Establishing appropriate governance structures is vital to affecting clinical practice change

The experiences of health services has shown that executive-sponsored governance structures, such as implementation working groups, have contributed to the successful implementation of smoking cessation practices and interventions across units.

Implementation working groups have been used to discuss and overcome barriers; learn from experiences across the service; promote clinical leadership; and highlight the achievements of units through feedback.

Ideally, these governance structures should have responsibility for development and implementation of local smoke-free policies and procedures, including:

  • funding to support implementation of smoking cessation and managing nicotine-dependence interventions
  • operationalising smoking cessation within clinical governance, and quality and safety frameworks
  • monitoring and reporting on implementation of policies and procedures.
Success factors

Success factors

  1. Leadership supported by smoke-free policies and protocols

    Ensure that there are smoke-free policies in place within the local health district (LHD) that include:
    1. Smoke-free grounds
    2. Patient support services
    3. Employee cessation supports
  2. Inter-disciplinary involvement

Encourage inter-disciplinary leadership across the LHD to ensure key clinical areas are involved in the management of nicotine dependence and smoking cessation care (such as cardiac and respiratory technicians, nurse specialists, respiratory doctors and physiotherapists, medical doctors, cancer doctors, pharmacology leaders, cardiothoracic surgeons and sleep physicians).

Ensure that smoking cessation implementation working groups include clinicians from a range of disciplines (e.g. medicine, nursing, allied health, psychology, physiotherapy and health promotion).

Suggested actions

Promote the importance of smoking cessation with management in all relevant forums, such as senior management meetings.
Engage with staff, patients and community stakeholders (possibly through consumer engagement processes) to promote the importance of smoking cessation, and collaborate with champions and clinical leaders to obtain buy-in.
Use leaders and executive managers to endorse a systematic approach to smoking cessation across the LHD.
Establish appropriate LHD governance structures with oversight of smoking cessation strategies. Where possible, appoint senior executives as Chairs of smoking cessation implementation working groups.
Standardise smoking cessation and related policies, protocols, guidelines and clinical tools; and encourage health professionals to suggest ways to integrate smoking cessation into routine care on their ward or within their health unit.
Instigate a communications strategy, which includes strategies that:
  • promote leadership endorsement of smoking cessation strategies
  • keep the issue of smoking cessation and practice change on the agenda
  • promote access to statewide and local tools, resources and training
  • facilitate smoking cessation interventions and referral to NSW Quitline
  • promote examples of successful clinical leadership.


1. Wiggers J, Vashum K, Wolfenden L, Yoong S, Paul C, Williams A, Bowman J. Implementing nicotine dependence and smoking cessation care in hospitals: an evidence check rapid review brokered by the Sax Institute (www. for the NSW Ministry of Health, 2016.