Health system is 'proud to be smoke-free'

Communication is key to successful switch

Health care workers taking a break and smoking in the cafeteria, the hallways, or even beside the loading dock don't exactly convey the image of a healthy environment and lifestyle that hospitals seek to promote. Increasingly, hospitals and health systems are adopting a smoke-free policy that applies to patients, visitors, and employees alike.

The shift to a smoke-free environment can occur smoothly if you have the support of senior leadership and you involve employees in the change, says Michael Lischak, MD, MPH, medical director of Corporate WORx, the occupational medicine and hospital employee health division of Columbia-St. Mary's Health System in Milwaukee, which has four hospitals and 30 clinics.

Columbia-St. Mary's felt a strong motivation to take the step. After all, many cities and states have already instituted smoke-free public facilities and limitations on smoking in restaurants and other gathering places.

"The health care industry should be exemplars of a healthy lifestyle," says Lischak. "It's just inconsistent with our whole health and wellness mission to allow smoking in a health care facility."

Columbia-St. Mary's effort began with a senior executive level working group that met to determine the best way to implement a smoke-free environment. They took a deliberate approach, anticipating some resistance among smokers. "We consciously took our time," says Lischak. "We took about a year [to introduce the program]."

The easier part was developing the policy. "The policy is really simple to state. It's no smoking anywhere, anytime by anyone, anywhere on the premises belonging to the hospital." There are no special smoking lounges. Employees and visitors may not smoke in the parking lot. There are no more smoking breaks. "We are truly smoke-free," says Lischak.

Making a smooth transition

To provide a smoother transition, the steering committee involved employees, managers, and security personnel, who would be involved in enforcing the no-smoking rule. The health system held focus groups to give employees a chance to express their views on a smoke-free environment.

Predictably, some smokers were opposed. "There were some folks who showed up and said, 'You can't do this, we don't want you to do that.' We quickly clarified whether we're going to be smoke-free was not negotiable."

In fact, even the medical staff of one of the hospitals expressed reservations. A physician from the Centers for Tobacco Research in Madison, WI, came to speak to the medical staff and convinced them of the importance of the effort.

In keeping with the theme of being "anti-smoking" not "anti-smoker," the health system provided support to smokers. Standing orders enable patients and employees to readily receive nicotine replacement therapy. The benefit plan was changed to cover smoking cessation classes and treatments.

A random survey of employees revealed that only 12% smoke, while about 21% of adults are smokers, says Lischak. He hopes that a repeat survey conducted a year after the launch of the smoke-free policy will show a drop in the number of employees who smoke, although he notes, "The reason we did this was not to get our employees to quit smoking. That would be a nice consequence, but it wasn't the reason."

'Proud to be smoke-free'

The "Freedom from Smoking" policy went into effect July 4, 2005, with "Proud to be smoke-free" buttons. By that time, Lischak had worked with the local medical society to create a smoke-free collaborative, and other hospitals in the area agreed to adopt a smoke-free policy, as well.

That allayed fears that smoking employees would quit and move to another hospital in the area. "We have had no employees quit because of the policy," he says. "To the best of my knowledge, we haven't disciplined any employees. We really had virtually no complaints; it's really gone very smoothly."

Communication was important in the transition, Lischak says. The new policy was announced about six months before it became effective. Managers were educated at their regular management meetings. They will address violations of the policy as they would any other work rule, by issuing reminders and verbal warnings — and further disciplinary measures, if necessary.

Creating a smoke-free environment is not as difficult as it may seem, says Lischak. It just requires commitment and some options, such as nicotine replacement therapy. Lischak has this advice for hospitals that want be become smoke-free:

"Plan for it. Involve employees. Explain the message very clearly, a positive message about health and about a health care system setting an example. Smoking is just incompatible with the mission of a health care facility. It's sort of tragic that it's taken us this long to realize that."