Barriers and challenges of implementing tobacco control policies in hospitals: applying the institutional analysis and development framework to the Catalan Network of Smoke-Free Hospitals.
ABSTRACT This article analyzes tobacco control policies in hospitals based on the experience of the Catalan Network of Smoke-Free Hospitals, Spain. The objective is to understand through this case study how tobacco policies are designed and implemented in health care organizations. Because tobacco control is a public health issue, governmental, institutional, and professional involvement is necessary. This article identifies and examines the structure and relationships among the different actors involved in the tobacco control policies in health care organizations using Ostrom's Institutional Analysis and Development framework.This theory helps one understand the policy failures and rethink the future challenges. Critical issues should be reviewed to enhance implementation of smoke-free hospitals-such as assuring the compliance of nonsmoking areas and introducing compulsory tobacco cessation activities that are promoted and monitored by the public administration. The author suggests that relying primarily on an organization's interpretation of rules leads to irregular implementation.
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ABSTRACT: Secondhand smoke exposure is a major public health issue, increasing the risk of cardiovascular and respiratory diseases and cancer. Although best practices for adopting smoke-free policy are well understood, there is limited research on the effective implementation of smoke-free policy. This article presents theoretical and practical considerations for smoke-free policy implementation in three Kentucky communities guided by the Institutional Analysis and Development (IAD) Framework. Although both Danville and Lexington-Fayette County, Kentucky have comprehensive smoke-free policies, Danville had more effective implementation, as well as better outcomes. Further study is needed to understand the critical elements of smoke-free policy implementation and their association with population outcomes. The IAD is a promising model to guide the study of both policy adoption and implementation. © The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.Policy Politics & Nursing Practice 01/2015; 15(3-4). DOI:10.1177/1527154414562301