The winds of change began in the west and have moved across the state as hospitals look at rules regarding smoking on campus by employees, patients and visitors. The latest policy changes have come out of East Tennessee where several hospitals have adopted a tobacco-free workplace, and one has opted to no longer hire employees who use nicotine at all.

 

At the beginning of this year, executives with five major Knoxville area health systems put employees on notice that the hospitals would become smoke-free workplaces by Jan. 1, 2011. The affected systems include Blount Memorial Hospital, Covenant Health, East Tennessee Children’s Hospital, Mercy Health Partners and The University of Tennessee Medical Center.

 

Joe Landsman, president and CEO of UT Medical Center, said that he and the other system leaders in the area meet routinely to discuss issues impacting healthcare in the region. “We felt, as healthcare providers, it was important to set an example for healthy lifestyles,” he explained. “We’re in a region of the country where a large percentage of our population does smoke … does use tobacco.” According to the CDC, Tennessee has the sixth highest percentage of smokers and the 14^th highest percentage of smokeless tobacco product users in the nation.

 

In announcing the decision, his colleagues echoed the sentiment. “The Knoxville area hospitals are working together on this initiative because the evidence is compelling and the message is clear: A tobacco-free workplace promotes better health, and better health is the shared goal of every hospital in this area,” noted Anthony L. Spezia, president and CEO of Covenant Health. Similarly, David Jimenez, CEO of Mercy Health Partners, said, “As the health systems in Knoxville are among the largest employers in the area, this joint announcement shows that we are serious about attempting to lower the smoking rate in this community.”

 

One of the reasons the announcement was made a year in advance, noted Landsman, was to allow employees who currently smoke every opportunity to avail themselves of tobacco cessation programming offered through all the health systems. He said that on his campus, it is estimated less than 5 percent of employees are smokers and about half of that group has expressed interest in quitting. He added, “By far, the feedback I’ve received (from employees) has been very positive and supportive.”

 

Although disciplinary actions are subject to each health system’s internal rulemaking, Landsman said a tobacco-free workplace policy would be enforced just like any other policy. “We’ll go through our normal procedures,” he said, but added, “We expect a high rate of compliance.”

 

As for extending the policy to the entire campus, Landsman said he could only speak on behalf of UT Medical Center. “I have asked for research to be conducted on the clinical impact to our patients and their visitors when you remove tobacco from them during stressful situations,” he said, adding he expected to make a decision on eliminating outside smoking areas within the next few months. He also stressed that employees have never been allowed to use the designated smoking areas set aside for patients and visitors so those remaining areas would have no impact on the enforcement of a tobacco-free workplace.

 

Memorial Hospital in Chattanooga has taken the concept a step further by ceasing to hire anyone who tests positive for nicotine — including the nicotine present in smoking cessation devices such as gum or patches — during routine pre-employment drug screening. The new policy went into effect in February of this year but does not retroactively pertain to those already on staff. No current smokers have been threatened with losing their job if they use tobacco products outside of work hours. Since it applies only to new hires, the legality of the policy isn’t in question … although it has certainly engendered comment and debate.

 

Brad Pope, vice president of human resources for Memorial Health Care System, which is part of the non-profit Catholic Health Initiatives, said it was really the next step in an ongoing initiative called “Healthy Memorial,” which was implemented to improve the health of the community and the systems’ employees. He added that Memorial, which had previously established a tobacco-free campus, is certainly not the only employer in the nation who has taken this next step. Notably, the esteemed Cleveland Clinic instituted a similar policy in the fall of 2007.

 

Pope also pointed out the CDC first issued reports on the health hazards associated with smoking more than four decades ago. “We’re sitting here 45 years later still challenged by this issue,” he said of the need to take action against the number one preventable cause of death.

 

“Part of our mission statement for Memorial and for Catholic Health Initiatives says we are creating healthier communities,” explained Pope. “To meet our goals, we need to be taking steps for our community, which includes our employees, for them to improve their health.”

 

He added the health system could see … and anticipates seeing … some savings realized from healthier lifestyles but stressed that any financial gain is strictly a secondary benefit. “Honestly that’s not our focus. The bottom line is it’s the right thing to do, and sometimes the right thing to do is the hardest thing to do.”

 

Pope said the system was prepared for some backlash from those who disagree with the new hiring policy. “We did get that,” he said, “but we also got a lot of businesses in the Chattanooga area and leaders to applaud us for taking that step.”

 

The policy has already been put to the test. Pope said those who do not pass the health screen when applying for a job are pointed to available resources. “We encourage them to reach out and do what they can to quit smoking and quit using nicotine,” he said. Pope added that anyone could reapply for a position at any time. However, if a potential employee has failed a drug screen, it could take six months before they are eligible to be hired.

 

The seeds of the growing tobacco-free movement were planted more than a decade ago in 1992 when The Joint Commission imposed a standard, which required hospitals to adopt a non-smoking policy throughout all buildings. In the aftermath, most hospitals created designated smoking areas in an outside area.

 

At the time, less than three percent of hospitals nationwide extended the ban to include the entire campus. By the end of last year, a study conducted by The Joint Commission indicated the majority (60 percent) of non-federal acute care hospital campuses in the nation would have such policies in place. An existing federal law that requires all Veterans Administration hospitals to have a “suitable and accessible patient indoor smoking area for patients and residents” makes it virtually impossible for VA hospitals to adopt smoke-free or tobacco-free campus policies.

 

The nationwide movement didn’t really begin to gain traction, however, until around 2005-2006. Memphis hospitals were early adopters of the tobacco-free campus concept with their “All Out” campaign launched on Nov. 15, 2007 in concert with the Great American Smokeout^®. Nick Lewis, director of safety and assistant director of facilities services for Baptist Memorial Hospital – Memphis, recalled the leadership from area hospitals began building momentum for the move to tobacco-free in 2005 through the Memphis district of the Tennessee Hospital Association.

 

One of the important steps taken by the Tobacco-Free Steering Committee was to involve the communications representatives from each of the hospitals to standardize the message. Lewis said the hospitals also worked together to standardize policies, signage, and the definition of what was considered ‘tobacco-free.’ He noted, “We all stood on common ground.”

 

He also said the lead-up was important. A major public relations push, including billboards announcing the policy, was launched well before the initiative went live. The area hospitals, which used the ‘All Out’ brand, teamed up with the American Cancer Society and American Lung Association and used every available opportunity to get the new policy message before the public and employees.

 

“I think all the hospitals were able to gain support of their governing boards,” Lewis said. “Part of it was timing. This was about the time lots of studies were out about second-hand smoke. For Baptist, our mission is to preach, teach and heal so it falls right into our mission.”

 

Because of the groundwork laid in advance, Lewis said post ‘go live’ was relatively smooth. Even today, though, visitors sometimes need gentle reminders. “We have patients who are critically ill,” Lewis pointed out. “It can be stressful for family members. We stand firm, though, and tell them where they can go off-campus if they need to.” He added that sometimes people still try to smoke. “We’ll just politely remind them this is a tobacco-free campus. We try to make it as non-punitive and non-confrontational as possible.”

 

The steadfast adherence to the rule, however, comes not only from the belief that hospital systems should set the example but also from a patient safety standpoint. “There’s nothing worse than walking into a hospital through a cloud of smoke,” said Lewis. “We’re here to heal and to create healthy environments for our patients, staff and visitors.”

 

Not long after Memphis area hospitals went to smoke-free campuses, the hospitals of Saint Thomas Health Services implemented a similar rule in Middle Tennessee. Saint Thomas Hospital and Baptist Hospital in Nashville, Middle Tennessee Medical Center in Murfreesboro, and Hickman Community Hospital in Centerville all initiated the new policy on Jan. 1, 2008. Since then, most every other hospital in Nashville … including the for-profit TriStar facilities and academic Vanderbilt University Medical Center … have followed suit. Last month, Cumberland Medical Center in Crossville became the latest Tennessee health facility to implement a tobacco-free campus policy.