Initial progress on addressing tobacco is achievable and motivating. Having some early victories furthers motivation; however there is a need to anticipate some of the potential ongoing issues, barriers to fully addressing this issue, and plan to sustain long-term recovery and change. The final step of the ATTOC intervention focuses on how to support, encourage, and sustain organizational change – a level of change at which addressing tobacco is fully integrated as part of routine practices in addiction treatment programs.
Addressing Tobacco is about
culture change and organizational change. Such changes take time. Therefore, although recognizing improvements and successes is important, ATTOC Champion(s) and members of work groups cannot declare victory too early. Opportunities, challenges, and barriers will continue to arise. Many organizational changes are reversed when leadership changes, when environmental pressures are removed, or when, for whatever reason, the going gets tough. At such times, take a deep breath and remind yourself of the profound changes we have already experienced:
- Remember when agencies only treated alcohol dependence or only drug addiction or only mental illness?
- Remember when 75% of men in America smoked?
- Remember when we smoked in all buildings and it was normal to smoke? It is now becoming normal not to smoke. Only 3% of doctors now smoke.
Champions and the Tobacco Leadership Group need to continue their collaborative work over time, monitoring practice, publicizing successes, and providing meaningful supports to sustain change.
Task 1. Publicize successes.
It is important to make the most of successes that your agency achieves during the ATTOC intervention. To keep momentum growing and the change anchored, ATTOC Champion and members of the leadership team need to inform patients and staff at your agency, as well as community residents, about successes in addressing tobacco.
Task 2. Establish an infrastructure to sustain change.
Keep the Tobacco Leadership Team or integrate its work into the fabric of the agency’s culture and work. Create a Standing Committee to Address Tobacco. Get Human Resources, Employee Assistance Programs, and other key components of the agency to integrate this issue in their routine work. Provide all staff with “messaging” to help them tell others why tobacco is being addressed, what treatment options are available, and that there is hope for recovery. Link the agency’s work to other local and state-based tobacco initiative groups for ongoing training and support. Enforce the due process when needed.
Task 3. Maintain ongoing monitoring and feedback/adjustment loop.
Add tobacco addiction / recovery outcomes to the outcomes monitored by the agency. Performance Improvement / Continuous Quality Improvement efforts provide a framework for ongoing improvement. The Standing Committee to Address Tobacco may be the focus for an ongoing feedback and adjustment loop based on a regularly scheduled evaluation of the progress made. Most importantly, assess the causes of any shortcomings and take thoughtful action to address them. Periodically, you should:
- Assess your progress,
- Monitor your outcomes,
- Consider your lessons learned, and
- Forge recommendations to address problem areas.