Background: Systems First is a national coordination project designed to support New Zealand hospitals improve the ways in which they address the smoking of patients. It offers a pathway to strengthened organisational competence. The project upholds the importance of embedding best practice into the bricks and mortar of organisational life for there to be equitable and lasting change.

Discussion: This presentation will describe how Systems First coordination has been successful in guiding smokefree change in those DHBs that have actively engaged with the project. Working through smokefree coordinators, support has involved systems coaching, site visits, network meetings, information updates and regular phone support. A variety of project tools have been developed to give shape and focus to communication, information, assessment, planning and reporting. Smokefree coordinators have been supported to

„X assess (and re-assess) their hospitals against a smokefree hospital best practice standard.

„X revise their DHB smokefree policy to include commitment to supporting smokefree patients and language that signals this leadership.

„X prepare a lot of staff in a short time to implement smokefree screening systems.

„X design and implement systems and care pathways for identifying the smokefree status of every patient.

„X establish monitoring systems to indicate levels of smokefree identification, support (eg NRT) and referral to cessation services.

Conclusion: Systems First is smokefree change by design. The relationship between Systems First support and DHB participation is at its best when the terms of engagement between parties are understood, accepted, trusted and signed.