Illuminating Key Facilitators and Challenges in Health Systems Change

PDA's evaluation helped health systems describe facilitators and challenges in identifying tobacco users and connecting them to treatment.


As most people see a healthcare provider at least once per year, health systems are in a unique position to identify people that use tobacco, assess their willingness to quit, and to help connect those interested to tobacco dependence treatment. Many health systems, however, do not have standardized processes and systems in place to make this a routine practice.

Between 2014-2017, ClearWay Minnesota℠ attempted to address this gap by awarding two-year grants to five Minnesota health systems. The goal of the grant was to improve tobacco dependence identification and treatment delivery by implementing health systems changes using best-practices from the field.

ClearWay Minnesota℠ hired PDA to conduct a process evaluation to help gain a better understanding of what it takes to implement tobacco-related systems changes within and across the funded health systems.


PDA’s process evaluation involved conducting semi-structured, in-person interviews with key staff and leadership from each health system at the beginning, midpoint, and end of the grant. PDA also reviewed grantee workplans and other documentation such as progress reports, meeting notes, and presentations.


After synthesizing data across the five funded health systems, PDA identified key facilitators and challenges of the grantees.

Facilitators of Change for Treating tobacco depndence through systems change


  • Having a dedicated tobacco systems-change coordinator on staff
  • Obtaining buy-in from decision makers across the health system
  • Capitalizing on internal and external priorities
  • Involving healthcare team members in the design, testing, and implementation of new processes
  • Using the electronic health record (EHR) as a documentation and referral tool
  • Monitoring adherence to new protocols


  • Ensuring that all staff are trained on new protocols and procedures
  • Timeliness of EHR changes
  • Keeping tobacco treatment elevated as a priority

At the end of each two-year grant period, PDA created brief systems change case studies describing key strategies, successes, challenges, and lessons learned for each funded health system.

Overarching findings have been shared through posters at multiple conferences and in this paper published in the American Journal of Accountable Care. Results from this evaluation can be used by other funders of health systems change strategies, as well as health systems considering implementing systems change initiatives.

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Our Team

Our dedicated and talented team is united by our common desire to improve communities.

Ronan Murray

Ronan Murray

Assistant Evaluator II

Amy Kerr

Amy Kerr

Director of Evaluation

Mindy Krakow

Mindy Krakow

Senior Health Communications Researcher I

Heather Zook

Heather Zook

Senior Evaluator I