The most important step a hospital can take to protect visitors, patients and staff from the harmful effects of secondhand smoke is to pass a smoke or tobacco free policy for the hospital campus. Approximately half of the hospitals in the United States have such policies. To assist in the creation of a policy, the MTFHN has provided a sample model policy available for download.
Please find the available tobacco policies for the hospitals listed below. Each policy was collected between July and December 2009 for the purposes of posting it on the Maine Tobacco Free Hospital Network website as a resource.
Central Maine Medical Family
Catholic Health East
Eastern Maine Healthcare
Franklin Community Health Network
Maine Coast Health Care
Mayo Practice Associates
Mid Coast Medical Group
Pines Health Services
Download the model policy for sample language that you could use in your hospital policy.
The majority of visitors, patients and staff will adhere to a smoke-free policy if they know about it. Clear, concise communication of the policy and its purpose is the biggest key to its success. The steps and guidelines below can help ensure success.
Steps for communicating a new tobacco-free policy:
- Convene a diverse group as a planning committee to plan and implement the tobacco-free policy initiative. Be certain to include top administrators. Find champions in your organization to help lead the effort.
- Begin communication efforts twelve to six months before the policy will actually take effect. Make it a positive process and be proud of your efforts!
- Place banners on the exterior of the building and signs within the building announcing the hospital’s decision to become 100% tobacco-free campus-wide including the implementation date.
- Focus on existing smoking areas. Make sure to heavily cover any existing outdoor smoking areas (bench, gazebo, smoking hut) with signage.
- Prepare educational materials for staff about the new policy and how to respond to patients, employees and visitors. Include rationale and talking points. Develop information for patients to be sent in a pre-admission packet.
- Start a countdown. Place a sandwich board with a flip chart in a prominent place (near the front entrance of the hospital inside and/or outside, in front of the cafeteria, etc.). Use it as a countdown (number of days until the hospital goes 100% tobacco-free campus-wide) and begin 90-100 days prior to policy implementation.
- Place signs in major traffic areas. Attach signs to easels announcing that the hospital is going 100% tobacco-free campus-wide, and place in major traffic areas. After they have been in one location for a month, move them to a new location to recapture people’s attention.
- Incorporate messages into a plasma display panel located at the information desk. Include the announcement that the hospital is going 100% tobacco-free campus-wide, tips for successfully quitting, and information about resources.
- Place a major sign near the main entrance to the hospital.
- Modify or add to pre-existing “No Smoking” signs to let people know that the entire hospital campus, both inside and out, will be going tobacco-free.
- Create a press release and include local media.
Follow these general guidelines while implementing a new tobacco-free policy:
- Signs intended to be read from a distance need to be large. We recommend a sign that is at least 4 feet by 2 feet be mounted near the most public entrance to the hospital. In selecting color, fonts and layout, aim for high contrast and use a big and bold font. Test to make sure that people will be able to read the sign from their cars.
- Communicate a brief and simple message. For example, “This is a tobacco-free campus” or “We are a 100% tobacco-free campus.” For more ideas, please see the MTFHN’s template signage.
- It is crucial to include the word “campus” in all signage to communicate to people that this is different from the no-smoking indoors policy that they have become accustomed to when in the hospital.
- Include the international “No Smoking” sign for low-literacy populations.
- Be positive vs. punitive. Instead of reprimanding tobacco users who violate your policy, use constructive language to inform users of the policy, and encourage them to seek out appropriate quit resources that your hospital may offer.
- Keep a health focus. Any health care facility can use its mission and vision to support a tobacco free policy. Providing health care, preventative services, and a healthy example to the community are all reasons a hospital/health care organization can go tobacco-free. Studies have also shown that smokers who undergo surgery have a slower heal time than non-smokers.
- Offer counseling and treatment services. Most employees wish they did not smoke, so offering a program to help them quit shows a supportive effort and can be a win – win initiative. If your hospital/health care organization offers this service, advertise it! Comprehensive tobacco treatment health insurance coverage for employees, including coverage for medications should be a benefit for all employees and their dependents. Promote these resources well in advance of implementing your policy, so employees can use the change in policy as an impetus to quit.
- Make Nicotine Replacement Products available. Your tobacco-free campus policy is not asking anyone to quit, but making short acting nicotine replacement products (such as single dose gum or lozenge) available in the gift shop or from the pharmacy for people to use while on your campus can be a helpful step.
- Give advance notice before implementing the policy. Allowing employees enough time to adjust to the new policy will permit them to make their own decisions regarding tobacco. If they currently use tobacco, but the policy will not be implemented for 90 days, then they have the option of quitting, or readjusting their use schedule to fit the incoming policy. Also, by advertising the policy well in advance of its implementation, there will be fewer violations.
- Pay attention to hospital boundaries. Make sure that there are major signs at every interface between hospital and non-hospital property (for example, places where traffic enters the hospital campus from a main road).
- Determine the number of entrances to the hospital and place a sign close to each entrance.
- Install freestanding signage, especially along the exterior part of the hospital property, and in outdoor areas where people tend to smoke. If signs are only located on physical hospital buildings, people will have a difficult time understanding that the policy applies to outdoor areas as well as indoor areas.
- Display signs in all parking areas, including both surface and lot parking.
- Hospitals generally remove pre-implementation signage and install permanent signage the night before the policy will take effect. At this time, they also remove all smoking huts, cigarette disposal bins, and other smoking details. It is important to have all signs in place prior to implementation.
- Recommendations to Increase Compliance:
- Some benches where people have habitually smoked may need to be removed. One year after implementation, the benches can be returned with ample signage.
- After you implement the policy, continue to monitor your campus. Identify the areas where cigarette butts continue to accumulate and increase signage and coverage in these areas.
Regardless of the smoke- or tobacco-free policy you choose to adopt, it is key that you address enforcement of the policy seriously, with consistent and prompt response to any violation. Enforcement can run the gamut, but please consider incorporating some (or all) of the tips below to ensure successful enforcement:
- Try a “see something, say something” policy by giving all employees the chance to enforce the tobacco-free policy. For example, you can give employees business cards with the 100% tobacco-free message on it to hand out to people who are violating the policy.
- Consider assigning enforcement to a particular department such as Security or Maintenance. Ensure they have the proper tools, resources, and authority to respond to people who are violating the policy.
- Ensure that all employees are trained in how to talk with sensitivity and clarity to people who are violating the policy, and also when it is appropriate to call security. Include a short talking points card that staff can learn. Emphasize the policy is not about making people quit. It is about maintaining a healthy environment for all.
- Make sure appropriate signage or physical boundaries are distinguished to denote the policy. For example, paint a line 50 feet away from the doorway or post signage on all buildings. For sample template signage, the Maine Tobacco-Free Hospital Network provides printable PDFs you can use to develop signage for your campus.
- Ensure consistent messaging of the policy - include in employee and patient manuals, patient/volunteer/employee orientations, indoor and outdoor signage, etc.
- Be sure employee expectations and violation consequences are spelled out in the policy. Most organizations use a “Three strikes” approach.
- Consider implementing an odor/fragrance policy for your employees - this will cut down on employees who smell like smoke when they enter the building and interact with patients, thus reinforcing your consistent message.
Successful enforcement of the policy requires effective communication, and is dependent upon the consideration, thoughtfulness, and cooperation of everyone. Enforcement language should be included in the text of the policy. All must share in the responsibility for adhering to and enforcing the policy. Any problems should be brought to the attention of the appropriate supervisor and/or department head to ensure violations are handled promptly, with consistency in the manner that each violation is addressed.