Eli's Rehab Report

Distribute quick-reference scripts to help employees approach smokers.

With more and more hospitals, including inpatient rehab facilities, banning smoking anywhere on hospital grounds, it is time to help staff stamp out their smoking habit. Bringing staff on board to enforce a smoke-free mandate is critical to a successful ban -- and keeping surveyors happy.

Background: Approximately three percent of U.S. hospitals had adopted a smoke-free campus policy in 1992 when The Joint Commission first introduced standards requiring accredited hospitals to prohibit smoking within the hospital. From a public health perspective, the benefits of stricter anti-smoking policies are well established, was the view of Scott Williams, PsyD, former associate director in the Department of Health Services Research at The Joint Commission in a study, "The Adoption of Smoke-Free Hospital Campuses in the United States," which appeared in an online issue of Tobacco Control, a British Medical Journal Group publication in 2009.

The Joint Commission offered tips to kick start or boost a smoke-free campus campaign.

1. Incentivize Employees to Kick the Habit

Many hospitals that participated in the study structured their benefits packages to reinforce and provide incentives for employees -- and their families as well -- to quit smoking. Hospitals that participated in the study shared their experiences with compliance and enforcement.

Idea: Many of the hospitals raised their medical insurance deductible amount across the board, and then offered to lower the deductible if the employee met certain healthy lifestyle goals. For instance, if the employee lowered his blood pressure to a target level, controlled his diabetes, or quit smoking, he would receive a credit of $500 off the deductible amount for each wellness target he achieved. When the hospitals translated [wellness] into these financial incentives, more employees got on board.

Don’t be shy: Verifying smoking cessation is an important component of maintaining such an incentive structure. You can test [that employees were nicotine-free] at annual wellness fairs when it is time to renew benefits packages.

Offer support: Support employees in meeting their goal to quit smoking, particularly in the short-term. Facilities can offer counseling service and/or nicotine replacement therapy.

2. Make Snuffing Out Smoke a Community Effort

Launch your "kick the habit" campaign with positive communication materials and scripts for approaching smokers. Start a communication campaign well before implementing the policy, using everything from newsletters to emails to tent cards on the cafeteria tables to get the message across. One hospital even sent a notice by certified mail to each employee.

In addition, you can promote the smoke-free campus policy in the local media, with the local government, and among EMS workers.

Positive light: Put a positive spin on the smoke-free policy, rather than focusing on what people are prohibited from doing. Hospitals exist to help people be healthy, and supporting a smoke-free policy is the "right thing to do" from the perspective of promoting healthy behavior.

Help employees understand that it’s everyone’s responsibility to keep the campus tobacco-free. At the smoke-free sites, employees are encouraged to approach people who are smoking, whether they are patients, other employees, or visitors.

Recognize that some people aren’t comfortable approaching others. You can supply scripts, printed on quick-reference cards, to model how to handle the conversation. Some facilities have been known to create scripts for managers on how to start the no-smoking conversation with their employees.

Example script: The scripts say something similar to: "I don’t know if you are aware, but this is a smoke-free campus; smoking is not allowed here."

The common response people found was: "Oh, I am sorry; I was not aware," and then the person extinguishes her cigarette.

If employees don’t feel comfortable approaching another employee, they should be encouraged to approach a hospital/facility manager to report the incident. In addition, security personnel should be detailed to file reports and inform the manager if they catch an employee smoking on campus. If you anticipate a backlash against enforcement, take heart from the fact that the participating hospitals didn’t really experience it.

3. Incorporate Smoke-Free Into the Conduct and Disciplinary Code

Treat the no-smoking on campus policy the same way you would any other hospital/facility rule -- mainstream it. If the employee violates the policy, follow the usual disciplinary process.

Example: Most hospitals in the study treat an employee found smoking on hospital property progressively. First, the incident is brought to the attention of the manager. The manager works with the employee to address the issue and offers to help the employee get into a quit smoking program. Once the employee has the opportunity to change her behavior and come into compliance, the disciplinary process is escalated if the employee continues to violate the policy. One institution actually terminated an employee for repeated violation of the no-smoking-on-campus policy.

Whatever the penalty, HR professionals must take care to enforce the policy consistently and uniformly. Another way for HR to take the reins is to incorporate responsibility for enforcing the smoke-free campus policy into job descriptions. You can rewrite managers’ job descriptions to specifically include the non-smoking policy enforcement.

Getting started: While working on implementing a smoke-free campus or boosting compliance with an existing policy, you don’t need to reinvent the wheel. Seek out existing tools and resources and adapt them for your environment.

Resources: Start with this smoke-free campus tool from the Mayo Clinic:

• ndc.mayo.edu/mayo/research/.