Transcript Mercurial Market: the Business of Health in 2004

North Carolina’s
First Tobacco-Free Healthcare SystemPaving the Road
Presenters
• Sallie Beth Johnson, MPH, CHES
[email protected]
• Cindy Laton, BS
[email protected]
FirstHealth of the Carolinas
Community Health Services
Pinehurst, North Carolina
1-877-342-2255
Presentation Outline
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Learning objective
Methods for tobacco-free initiative
Results of policy change
Discussion of challenges and impact
Q&A (questions and answers)
Learning Objective
At the end of this presentation, participants
will be able to:
• Identify ways to engage a tobacco
growing community during the
adoption, implementation and
enforcement of a tobacco-free policy
FirstHealth of the Carolinas
• A private, non-governmental, not-for-
profit health care system serving 15
counties in the rural tobacco growing
region of the mid-Carolinas
FirstHealth of the Carolinas
• Three hospitals (Moore
Regional, Richmond
Memorial and
Montgomery Memorial)
• Primary care clinics,
health and fitness
centers, home and
hospice care, EMS and
health plan
• Core Purpose:
“to care for people”
FirstHealth of the Carolinas
(FHC)
• On July 4, 2004, FHC
declared “Freedom From
Tobacco”
• Adopting a comprehensive
tobacco-free policy that
prohibits staff, patients and
visitors from using tobacco
products anywhere on
campus
IMPACT- Look at the Numbers
• Policy affects 4,000 employees, 300
providers and 800 volunteers that work at
one of the 30 system sites
• Over 300,000 patients that receive care
and the family members and friends who
visit
• Estimated that 15-18% of FHC staff use
tobacco (600-800 individuals)
How Did the
Initiative Get Started?
• Tobacco control programs funded
through the American Legacy Foundation
& NC Health & Wellness Commission
• Working with local schools and youthoriented businesses on advancing
tobacco-free policies (A CHALLENGE!)
• Presented work to FH Community Health
Board and they recommended action,
FHC Board approved
Timeline of Events
• Board recommended policy change in May
2003
• Staff consulted on timeline & number of
tobacco users, June – August 2003
• Task force created in Oct. 2003
• Communications initiated in Jan. 2004
• Staff input on support requested in Feb. 2004
• Staff training on policy, May – July 2004
• Policy approved in June 2003
• Tobacco-free on Independence Day, July 4,
2004
Task Force and Plan
• Identified VP of Medical Affairs as lead
• Created a task force of non-smokers and
smokers
• Developed a plan that addressed:
• Communications
• Physician leadership
• Support
• Compliance (enforcement)
• Added topical questions to employee
satisfaction survey
• Identified local champions
Task Force Membership
Members enlisted:
• VP, Medical Affairs
• VP, Communications
• VP, Human Resources
• Board member
• Physician
• Director, Community
Health
• Director, Graphic Design
• RN, Cardiac Cath
Ad Hoc Members:
• Director, Corp
Education
• Director, Security
• Acct Mgr,
Communications
Should have included:
• Site-based Managers
• Director, Public
Relations
• Pharmacist
• Additional providers
Physician Leadership
• Invited physicians to be part of the task
force
• Held discussion of the policy elements at
medical executive committees & service
line meetings
• “Houston, we have a problem!”
Solutions….
– Exceptions for psychiatric patients
– Pre-printed orders for NRT for in-patients
– CME offered on medication assistance
– Simplified referral form for cessation program
Communications
• Researched other tobacco-free organizations
• Developed a timeline for audience-specific
strategies
• Created a plan for signage
• Shared premise paper with board &
administration
• Gained additional staff input
• Presented at medical staff, leadership &
service line meetings
• Developed and approved policy
Initial Communications
“The surgeon
general’s
warning on
cigarettes
should be
posted as
one of the
reasons.”
Employee
Responses
“Create a buddy
system or support
system of fellow
quitters.”
“Find cheaper
alternatives for
the gum, patch,
support drugs.
Our insurance
does not cover
these items and
they can be
expensive.”
“Discrimination will
occur if psych and
detox patients are
allowed to smoke and
not the rest of the
population.”
Additional
Responses
“I think it is a violation of
each person’s rights as
an individual. Rumor has
it that patients’ families
may smoke so you won’t
lose business?”
“What about all
the overweight
people? Why do
they have a
doughnut cart at
the cafeteria?”
FirstQuit- Cessation
Program……
• Customized quit plan
• 1:1 sessions
• Coping strategies
• Support groups,
workshops, resources
• Medications
Results…….
• Covering all
expenses of program
• 32% quit rate at 6
months
• 90%+ using
medication
• Combination of oral
medications & NRT
FirstQuit Components
• Trained personnel
– RNs and health educators (1.8 FTEs);
accessible at each hospital campus; 1 FTE
per 400 patients
• Training
– Freedom from Smoking, QuitSmart, Mayo
Clinic
• Medication assistance
– Offered at no charge (purchased
at cost)
– Utilized physician recommendations
FirstQuit Components
• Annual expense
– $105,000 for salaries/benefits
– $135,000 for medications/supplies/
mailings
– $80,000 for FH employees & family -$320/participant
FirstQuit Components
In FY04, 248 of the new 754 FirstQuit
clients (33%) were FirstHealth staff
350
January 1, 2004
July 4, 2004
300
250
200
150
100
50
0
1st Qtr
2nd Qtr
3rd Qtr
Community
FirstHealth Staff
4th Qtr
Compliance
(originally known as Enforcement)
• HR participation & leadership
• E-learning module for scripting
• Security staff role-playing
Ten months into the process……
• Labor law communications, “bus stop”
smoking
• Manager focus groups
• Inpatient assistance
– Physician orders allowing patients to smoke (5 times)
– NRT requests (370 patients, $15,000)
Ensuring Compliance ….
…..or the Aftermath
Key Components of a
Successful Implementation
• Create a comprehensive task force
membership
• Need staff support for task force
• Seek continual input from staff & smokers
• Expect resistance, but they are not the
majority
• Assess financial implications
• Mainstream the policy & enforcement in the
organizational culture
Key Components Continued
• Communicate & engage frequently offcampus sites
• Take initiative to engage staff who use
tobacco
• Create the perception of “no barriers”
for support
• Educators are not the enforcers
• Expect increased demands and anxiety
the week before the policy change
• Most people follow the rules
Elements of a Good Policy
• Address purpose and who it affects
• Identify geographic areas covered
• Note nursing, physician, employee,
patient and security staff
responsibilities
• Identify communications with
visitors
Policy should fit organizational culture
Community ImpactPaving the Road
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Tobacco-free advocacy youth groups
100% tobacco-free schools
Smoke-free dining campaign
Tobacco-free parks and recreation
Health department and local health
coalitions supporting resolutions for
increasing cigarette product pricing
• Media coverage, letters to the editor and
news stories devoted to tobacco use
Youth Empowerment
• Over 220 youth
trained to serve
as tobacco-free
policy advocates
New Signs in “Tobacco Country”
Changing Social Norms
• FirstHealth’s “Freedom from Tobacco” is
paving the road and changing the social
norms in a tobacco-growing community.
• Where it is said “100% tobacco-free will
never happen here”, changes are
occurring.
???
Questions