The team: Kerrie Luck (SFT Project Coordinator), Dr. Rob Stevenson (Cardiologist at NB Heart Center and SFT Medical Lead), John McGarry (Horizon Health Network President and Chief Executive Officer), Margaret Melanson (Vice President, Quality and Patient Centred Care for Horizon Health Network and co-chair of the Smoke-Free Together initiative), Jean Daigle (Vice President Community for Horizon Health Network and co-chair of the Smoke-Free Together initiative).

Horizon Health Network marked World Heart Health Day on September 29th 2015 by launching its new smoke-free environment policy at the Saint John Regional Hospital. This momentous step demonstrates true leadership in health and wellness promotion, which will move New Brunswick towards a brighter and healthier smoke-free future.

Project coordinator Kerrie Luck and medical lead Dr. Robert Stevenson have been instrumental in ensuring the successful implementation of the Smoke-Free Together initiative, which will be implemented at all Horizon hospitals over the next 12 months.

A Smoking Crisis in New Brunswick

Kerrie is an Occupational Therapist currently pursuing her Ph.D. at the University of New Brunswick Saint John Campus. She has many years of experience studying and working on smoking cessation, witnessing people’s struggle and victory over nicotine. She has a wealth of knowledge on the topic and is truly passionate about the issue. Both Dr. Rob Stevenson and Kerrie pushed the idea forward that the Saint John Regional Hospital should implement a policy to limit exposure to dangerous second-hand smoke.

“A significant number of staff, visitors and patients were being exposed to second-hand smoke while entering or exiting the hospital,” says Luck. “To give you an example, in one day, we counted 1,600 cigarette butts just outside the two main entrances. Plus, many hospital employees who smoke were expressing a desire for help in quitting smoking. We felt it was an opportune time to match interest with evidence in a true comprehensive smoke-free strategy.”

Kerrie Luck collected and counted cigarettes butts found near the Saint-John Regional Hospital’s main entrances, prior to the development of the new smoke-free environment policy.

“We have a smoking crisis in New Brunswick,” adds Dr. Stevenson, a cardiologist at the Saint John Regional Hospital. “We have one of the highest rates among all the provinces in Canada! We felt that hospitals should lead by example. I have seen patients come to the hospital for treatment and start smoking again after being exposed to second-hand smoke on the hospital grounds.”

This is alarming considering smoking is the leading preventable cause of premature disease and death. It’s no secret that smoking and exposure to second-hand smoke contribute to devastating health conditions such as cancer, chronic obstructive pulmonary disease (COPD), cardiovascular disease, and stroke. Policies such as smoke-free hospital properties help to not only minimize exposure to second-hand smoke, but also to de-normalize tobacco use and foster an environment that supports those who are trying to quit, or have already quit smoking.

The pair approached senior leadership just over 2 years ago to get the green light to research and develop a smoke-free policy for hospital grounds. The project soon gained momentum and enthusiasm; so much so that it became a Horizon- wide project. The Board approved the policy in April 2015. Luck and Dr. Stevenson’s committee quickly shifted gears, working around the clock to inform everyone and get the hospital ready for the official launch and implementation.

“At the very beginning, everyone was looking at us like we had two heads,” recalls Luck with a laugh. “But after a while, there was a shift in perception. People are on board and very excited about this policy!”

Brochure available for vistitors. There is also a wealth of information, including FAQs.

A Comprehensive and Holistic Policy – Implemented in Phases

Under its new Smoke-free Environment policy, the building and grounds of the Saint John Regional Hospital are 100 per cent smoke-free. All tobacco products/medical marijuana/herbal products intended to be smoked or heated, e-cigarettes/ENDS (Electronic Nicotine Delivery Systems) or any other smoking devices are prohibited on hospital property, including inside any vehicle parked on the grounds. The policy applies to all employees, volunteers, students, patients, visitors, vendors, contractors and others who work in or visit the hospital buildings, parking lots, and grounds.

“We call this Smoke-Free Together – it’s really about ALL of us – smokers and non-smokers – helping each other and ensuring our beautiful hospital grounds are entirely smoke-free,” explains Luck.

Kerrie and Dr. Stevenson combed through the literature and talked with many hospitals that had already gone smoke-free to learn from their successes. Six working groups were set up: policy; compliance; communications, awareness and engagement; training; employee support and patient support. Each had different actions to undertake to ensure everyone had the information and tools needed to respect the policy.

“One of our best decisions was to choose to implement the new policy in a phased approach,” says Luck. “We knew that people need time to adjust to change. So, we pre-launched the policy internally in July 2015, so we plastered the walls with posters and held meetings with management and staff. We wanted to make sure our internal audience, hospital staff, knew the reasoning behind this new policy as well as the role we expected them to play. We wanted to make them comfortable with the policy and show them how they could help each other follow it.”

Dr. Rob Stevenson speaks at the launch of the Smoke-Free Together initiative at the Saint-John Regional Hospital.

Employee Support and Training

Another key element contributing to the Smoke-Free Together initiative’s effectiveness is free employee support for quitting smoking. Counseling and smoking cessation aids, such as nicotine replacement therapy (NRT), are provided through Horizon’s Employee Health and Wellness Department. Over 225 staff members are currently enrolled in the hospital’s smoking cessation support services.

“Most people who initially were angry or reluctant about the policy are now seeing it as an opportunity to make a change in their lives,” says Luck. “For example, a man who had been smoking since the age of 13 recently came to thank me and to tell me he was now smoke-free, going to the gym for the first time in his life and feeling healthy and fit. He is one of those employees that his manager had warned me might be quite vocal against the new policy. His initial anger quickly turned into a ‘how can I make this work for me?’ attitude. It’s so inspiring! I have witnessed and been touched by many similar stories.”

“This is not an ‘us’ versus ‘them’ policy. We are smoke-free together,” adds Dr. Stevenson. “We want employees to know we are not stopping them from smoking; they can still smoke, just not on hospital grounds. And for those who want to quit, we’re fully committed to support them along their journey. It’s so much harder to quit smoking if you are in an environment that does not support it. Our policy aims to foster a healthy and safe environment for everyone.”

Small group awareness sessions with staff in different departments ensured employees could ask questions in a non-intimidating environment and get all the information they needed to prepare for the launch of the policy. Smokers had time to reflect and start seeking help well in advance so that the new policy would not be too much of a shock.

Staff can also refer at any time to an internal web page with plenty of information and resources, such as videos showing how to approach a smoker, FAQs, links to smoking cessation resources and information on the tools developed to help staff, patients, and visitors respect the new policy.

“While we have trained our security personnel, ensuring compliance of the new policy is not just their job,” cautions Luck. “Everyone can play a role. For example, we’ve implemented a buddy system for managers and made it part of their work tasks to take turns walking the grounds, armed with a smoke-free information handouts. We’ve trained them on how to approach individuals who may be smoking and not respecting the policy in a positive and non-confrontational way. We’ve also given managers training on how to help their employees follow the policy. They are expected to hold their team accountable and to discipline staff, much like they would for any work-related issue like tardiness or not wearing their uniforms.”

The team and hospital staff inaugurate the launch of the Smoke-Free Together initiative with a symbolic “butt out”.

Visitor Education and Patient Comfort

Big signs and banners inform visitors of the smoke-free environment policy as they enter the hospital grounds. There are signs everywhere in the facility as well. Maps explain the policy and show the boundaries of the hospital grounds.

Of course, some members of the public have expressed some worry about the idea of patients not being able to smoke while in the hospital. “It is important that patients who are current smokers know they will be comfortable during their stay,” says Luck. “Each patient admitted to the hospital is screened for tobacco use and given NRT so that he/she can be comfortable and doesn’t feel the need to go outside and smoke. We also support patients who want to take advantage of their stay in the hospital to start the process of quitting smoking.”

Visitors are encouraged to discuss NRT options with their pharmacist if they plan to be on hospital property for extended periods of time. Nicotine gum is available for sale at the hospital’s gift shop. Plus, visitor kits are available to keep smokers comfortable, containing things to distract smokers from their cravings, like Sudoku puzzles.

Implementing the Policy in Other Facilities

The Smoke-Free Together initiative and policy will be implemented at all other Horizon hospitals in 2016.

“Most of the work is being tried and tested at the Saint John Regional Hospital,” explains Luck. “We’ve developed all the tools and marketing materials, such as templates for signs, FAQs, training videos, etc. We have timelines each facility can respect to implement the policy in phases, like we did for the Saint John Regional Hospital. Each facility will have a project lead and a medical lead responsible for the implementation of the policy. We’ll be doing some ‘train the trainer’ type of work with management in each facility.” .

There is a positive change and lots of enthusiasm and pride at the Saint John Regional Hospital since the launch of the new policy. Kerrie Luck, Dr. Stevenson and everyone who worked on the smoke-free initiative should be applauded for the incredible work and dedication they have shown towards this project.

“I will save more lives with this smoke-free policy than I ever will throughout my lifetime as a cardiologist,” says Dr. Stevenson. “Prevention is the key to good health. Doctors always tell people to eat better, be physically active and take care of themselves. It is very hard for most people to do these things. Smoking is so toxic that the very nature of quitting has immediate health benefits. We know that we are saving lives when someone quits smoking.”

“I am seeing change happen right in front of my eyes,” adds Luck. “Attitudes are shifting and employees are motivated to quit smoking.”

Photos and story used with permission from the Saint John Regional Hospital and Horizon Health Network.

Published in November 2015

By Nathalie Landry – NBATC Communications Coordinator