Transcript Mercurial Market: the Business of Health in 2004
North Carolina’s First Tobacco-Free Healthcare System-
Paving the Road
Presenters
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Sallie Beth Johnson, MPH, CHES
Cindy Laton, BS
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
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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
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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
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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)
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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
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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?
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Tobacco control programs funded through the American Legacy Foundation & NC Health & Wellness Commission Working with local schools and youth oriented 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
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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
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Identified VP of Medical Affairs as lead Created a task force of non-smokers and smokers Developed a plan that addressed:
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Communications Physician leadership
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Support Compliance (enforcement) Added topical questions to employee satisfaction survey Identified local champions
Task Force Membership
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Members enlisted: VP, Medical Affairs VP, Communications VP, Human Resources Board member Physician Director, Community Health Director, Graphic Design RN, Cardiac Cath
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Ad Hoc Members: Director, Corp Education Director, Security Acct Mgr, Communications
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Should have included:
Site-based Managers Director, Public Relations Pharmacist Additional providers
Physician Leadership
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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….
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Exceptions for psychiatric patients Pre-printed orders for NRT for in-patients
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CME offered on medication assistance Simplified referral form for cessation program
Communications
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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.” “Create a buddy system or support system of fellow quitters.” Employee Responses “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.” “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?” Additional Responses “What about all the overweight people? Why do they have a doughnut cart at the cafeteria?”
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FirstQuit- Cessation
Program…… Customized quit plan 1:1 sessions Coping strategies Support groups, workshops, resources Medications
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Results…….
Covering all expenses of program 32% quit rate at 6 months 90%+ using medication Combination of oral medications & NRT
FirstQuit Components
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Trained personnel
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RNs and health educators (1.8 FTEs); accessible at each hospital campus; 1 FTE per 400 patients Training
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Freedom from Smoking, QuitSmart, Mayo Clinic Medication assistance
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Offered at no charge (purchased at cost)
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Utilized physician recommendations
FirstQuit Components
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Annual expense
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$105,000 for salaries/benefits
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$135,000 for medications/supplies/ mailings
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$80,000 for FH employees & family - $320/participant
FirstQuit Components
350 300 250 200 150 100 50 0 In FY04, 248 of the new 754 FirstQuit clients (33%) were FirstHealth staff January 1, 2004 July 4, 2004 1st Qtr 2nd Qtr 3rd Qtr Community FirstHealth Staff 4th Qtr
Compliance
(originally known as Enforcement)
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HR participation & leadership E-learning module for scripting
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Security staff role-playing
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Ten months into the process……
Labor law communications, “bus stop” smoking Manager focus groups Inpatient assistance
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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
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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
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Communicate & engage frequently off campus 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
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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 Impact Paving 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
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Over 220 youth trained to serve as tobacco-free policy advocates
New Signs in “Tobacco Country”
Changing Social Norms
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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.