ABSTRACT
The adoption, implementation, and sustainability of an inpatient tobacco cessation program in standard hospital practice requires a strong multilevel support structure within the hospital. Even when the proposed program offers visible benefits to patients, quality of care, and staff, the initial reactions to the program might be resistant or even negative. Less than positive reactions can result from territory-protection issues, struggles for limited resources, concerns about additional work volume, competition over what programs get the spotlight, defensive interpretations that a new program means providers are not currently doing an adequate job, cross-discipline conflicts, low morale, new-initiative burnout (flavor of the month), and/or cynicism (“we've tried that before and it didn't work”). Change of any sort is often difficult and uncomfortable because it disrupts the status quo, breaks up routines, often leaves people feeling inefficacious, and is unsettling.
