Table 1.

Linking stakeholder-generated system insights with potential leverage points and action ideas

Viewpoint	System insights	Potential leverage points	Action ideas	Representative quote
Provider	Patients frequently leave the floor to smoke, which creates major workflow problems; as a result, providers are more compelled by ‘reducing nicotine withdrawal’ rather than ‘cessation’ efforts	Interventions to reduce nicotine withdrawal symptoms and framing solutions around nicotine replacement and workflow to foster provider engagement	Use nurse-driven protocols to ensure that readily accessible nicotine replacement therapy can be provided to inpatients with little delay	‘People go down to smoke and they miss meds and even appointments which is so frustrating’. (Staff nurse)
Provider	Providers lack awareness of existing cessation resources to connect patients at discharge, which negatively impacts their willingness to provide inpatient smoking cessation care	Education and decision support	Use continuing medical education, roving in-services, quick reference tools, and brief videos to train providers on how to implement existing and effective treatments Design electronic health record modules to support point-of-care treatment decision	‘I would like to know more about free or low-cost smoking cessation treatment centers to which I can refer my patients…if there was some way they could get [medications] at low cost along with smoking cessation therapy, I think that would be beneficial’. (Resident physician)
Provider	Enthusiasm to improve inpatient smoking cessation is balanced by concern about demands and limited time	Standardised and coordinated approach to smoking cessation treatment	Provide point-of-care brief advice, opt-out medication and discharge links to community resources, including quit-line counselling, to every patient who smokes	‘Most of us would love to help them quit smoking, but it is time consuming…thereby making it feel very much like extra work and easily dropped when busy’. (Resident physician)
Patient	Patients are often asked about their smoking but very rarely assisted with cessation	Transparency regarding patient interest in and use of treatment	Give providers feedback on individual and aggregate rates of offering smoking cessation treatment, as well as patient interest and engagement with cessation support Develop cessation plan for discharge	‘I’m so tired of being asked if I’m a smoker without being offered help to quit. It seems like they are only asking so that they can check a box and move on’. (Patient)
Patient	Patients are more compelled by positive and non-judgemental communication	Patient-provider rapport through more supportive cessation messaging	Ask every patient who smokes if they would like to help quit smoking Revamp hospital signage to incorporate positive messaging on smoking cessation	‘The more respect staff gives, the more honest the conversation is, and the more likely I will be to accept treatment’. (Patient)