Clearing the Air Creating a Smoke-free Work Environment Poses Many Challenges

When Baystate Health started down the road toward a smoke-free work environment more than a year ago, it had people like Marie Brown in mind.

The supervisor of special billing for the Baystate Medical Education and Research Foundation, Brown was a 42-year smoker — with the accent on was. She had tried many times to quit, but without success, and admitted she was in need of a good push.

She got one in the form of Baystate’s two-stage campaign to become smoke-free.

Stage II, set to begin March 20, the first day of spring, calls for a full ban on smoking at all Baystate facilities. The policy is detailed, but, in simple terms, it boils down to this: people (and this means everybody — employees, patients, visitors, vendors) can’t smoke anywhere on the premises, meaning buildings and grounds. Meanwhile, employees can’t smoke while representing the health system in any way and at any time.

Brown wanted to be ready for when the clock struck midnight, so she quit last summer — June 11, to be exact. She has good days and bad days, but, with the help of nicotine-replacement therapy, she considers the battle won.

Brown’s story has been repeated hundreds of times across the Pioneer Valley as a growing number of companies, mostly larger employers, have created smoke-free work environments or are in the process of doing so. May 1 is the go date at Smith & Wesson, July 1 is the date circled on all the calendars at Big Y Foods, and Nov. 15, the date of the Great American Smokeout, is D-Day at Northampton’s Cooley Dickinson Hospital.

These institutions will join many others that have already gone down this road, including Hasbro, Springfield’s Marriott hotel (no smoking in any of the rooms), Channing Bete, and Health New England, the health insurer that is now taking an active role in helping other companies make the move.

The policies vary in small ways, but the common denominator is that smoking is or soon will be fully banned at the workplace in question. In most cases, employers say they’re not telling their workers they can’t smoke, not in those terms, exactly; they’re just making it much, much harder to do so — at places like Hasbro, Smith & Wesson, and Baystate Medical Center, employees will not be permitted to smoke on paid time, and will have to walk several hundred yards to get ‘off site.’

The businesses that have gone smoke-free, or are in various stages of doing so, say the primary motivation is to improve the overall health of their workforces and workplaces, and that the smoking polices are part of broader efforts that include health screenings, reimbursements for gym memberships, creation of on-site fitness centers, and establishing so-called ‘walking clubs.’ But there are other, practical reasons for joining the movement.

“We pay roughly $10 million a year for health insurance,” said Bill Lachenmeyer, vice president of Human Resources for Smith & Wesson. “If we can’t knock a few percentage points off that through programs like this, it’s well worth it.”

Creating a smoke-free work environment isn’t easy; there is work to be done at several levels, from policy creation to help with smoking-cessation programs to enforcement of the new policies. Those who have been through it all say the process is best implemented in stages, first limiting smoking to one or a few areas and then banning it completely. It’s recommended that the countdown to smoke-free status be at least six months to give those who want to quit ample opportunity to do so.

Despite the time, energy, and expense involved in the process, those companies that have taken this road say it’s been worth it. They predict they’ll see it in lower health-related costs, and can already see it on the faces of people like Marie Brown and Big Y’s Kelly Mullahy, who just needed that push.

“I just needed something to help me get over the hump,” said Mullahy, customer service sales manager of the chain’s Newton Street store in South Hadley, who quit last summer. “This did it for me.”

In this issue, The Healthcare News looks at why companies are moving toward the smoke-free work environment, how they manage the process, and what they gain from clearing the air — literally and figuratively.

Leaders of the Pack

MaryLynn Ostrowski remembers the reaction when Health New England announced in the fall of 2005 that it was going to create a smoke-free work environment.

There was some minor grumbling from the smokers, general support from the workforce as a whole, but also a minor undercurrent of concern, an Orwellian fear over what might come next.

“People were afraid that they were going to be asked to lose 50 pounds,” said Ostrowski, HNE’s director of Health Programs and Community Relations.

People started thinking, ‘am I going to have my body fat measured twice a day?’”

Concern over what could be next is part and parcel to going smoke-free, said Ostrowski, a fear that is usually overcome quickly and easily through education and communication with employees. It’s part of what should be a “thoughtful, caring process,” she continued, adding that before HNE embarked on its journey to a smoke-free work environment, administrators there researched the matter exhaustively, listening to those who had gone before them about what they had done and, perhaps more importantly, what they might have done differently if given the chance.

“We did some best-practices research involving several regions of the country, including one town in upstate New York that went entirely smoke-free,” said Ostrowski, who now spends considerable time assisting other companies with the formation of their policies. “We wanted to find out what people learned, and we took those lessons and applied them to our own policy.”

The drive to go smoke-free is a national phenomenon, said Ostrowski and others who spoke with The Healthcare News, and one where many regions of the country have moved out ahead of the Northeast and, specifically, Western Mass. Nationally, such companies as Northwestern Mutual Life, the Mayo Clinic, the University of Michigan Health System, Calgon, and Alaska Airlines have made the transition. Health care providers have led the charge, but the movement has touched all sectors, including manufacturing, where company owners, pressed to take every step possible to remain competitive, are making the change.

“I was in the Midwest for seven years before coming to Smith & Wesson,” said Lachenmeyer, “and this is old hat out there.”

Western Mass. companies are catching up, however, with several making the move this year, and many others making inquiries to HNE, Baystate, or other businesses about how to join the trend.

It all begins, said Ostrowski, with a firm commitment from top management — without it, the transition can’t happen. That commitment can be born of economic considerations, corporate culture, one’s mission in the community (a key ingredient for health care providers), all of the above, or simply the realization that this is the proverbial right thing to do.

“We’re a managed care organization, and we’re about maintaining good health and preventing preventable types of illnesses,” she said. “And smoking is one of the things that contributes to all kinds of health risks. So we thought it was important for Health New England to become a model when it comes to the smoke-free work environment.”

At Smith & Wesson, the drive to go smoke-free is part of a broad focus on improving the overall health of the workforce, said Lachenmeyer, adding that this strategic initiative has also included an expansion and modernization of an on-site gym (coupled with incentives to use it), distribution of pedometers and encouragement to walk, less junk food in the vending machines, and other steps.

There is clear motivation for such actions, especially the smoking ban, he said, citing demographics within the plant that contribute to higher health insurance costs.
“We have an older workforce — 25{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of our people are getting close to retirement,” Lachenmeyer explained. “We have a lot of older workers and many younger workers, with very few in the middle.”

If the company’s workforce reflects society in general, roughly 20{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of that workforce smokes, he said, adding that it is the company’s goal to reduce that number to zero if at all possible, but certainly to something lower than the current level. Part of the company’s strategy is to convince employees that it’s in their own best interest (in the form of lower, or at least not higher, health insurance contributions) to take steps to help make the workforce healthier. Steps like quitting smoking.

At Baystate, the decision to go smoke-free is part of a broader strategic planning initiative called the ‘Culture of Health,’ which, as the name suggests, is devoted to improving the overall health of those served by the system, said its CEO, Mark Tolosky.

“We thought that an integral part of that was the health of our own employees and their families,” he explained. “We believed that, as a progressive employer and, particularly, being a health care leader, there were some things that we could do better and differently, and one was showing leadership in creating a smoke-free work environment.”

Thorough research on the subject led the team charting Baystate’s course to choose a two-step process, he continued, adding that he expects the final phase will go as smoothly as the first — which limited smoking to one area at each site and prohibited smoking on paid time —because of the tremendous amount of thought and study that went into the initiative.

“We looked at multiple options, with the goal of being fair to our staff, fair to visitors, and fair to our organization, while making a real statement about being a leader in health,” Tolosky said, adding that he now hopes Baystate’s example might inspire others — in the health care community and outside it — to take a similar route.

“There are a number of reasons why people may not want to embark on this journey,” he continued. “Once they see that an organization can do this and in a way that’s respectful and in partnership with employees, and the organization is not hurt by it, but in fact is enhanced by it, they may evaluate it more seriously.”

No Butts About It

While all campaigns to go smoke-free have been somewhat daunting, Baystate’s initiative is by far the most complicated and far-reaching in this region. It involves several dozen facilities stretched across Western Mass., more than 9,000 full- and part-time employees, and a host of constituencies, including patients, family members, physicians, ambulance drivers, expecting parents, vendors of all varieties, even the media, which shows up on an almost daily basis chasing down stories ranging from cold-weather health tips to what mental health issues would drive an astronaut in a love triangle to try and take out the competition.

Starting March 20, all those groups will have to abide by one clear and simple rule: There is no smoking on the grounds — anywhere!

At the moment, there is just one place where people can smoke at Baystate Medical Center: Outdoors, behind the emergency room, said Amanda Hopkins-Alexiadis, the system’s director of Behavioral Health, Neurosciences, and Rehabilitation Services, and co-chair of something called the Smoke-free Environment Implementation Team. That area was chosen in part as a nod to the stress that accompanies time spent in the ER — by patients, their family members (both groups must often endure long waits), and, yes, the people who work there.

Beginning March 20, people will have to find methods other than lighting up to handle that stress, said Hopkins-Alexiadis, adding that enforcement of the new policy, especially when it comes to patients and family members, will be a stern challenge requiring both a sense of compassion and the need for consistency.

Those two words describe — or should describe — every phrase of the process, she said, starting with the creation of the committee that will oversee the project. It should be a thoroughly democratic process, represent all departments within a company, and consider the needs and emotions of non-smokers and smokers alike.

Richard Corder, vice president of Operations and Facilities Management at CDH, said the hospital’s 12-member team is comprised of both non-smokers and smokers to prevent or minimize an ‘us versus them’ sentiment, which might prevail if the process is not handled properly.

“This is a facility that’s trying to promote good health,” he explained, adding that CDH, like other hospitals, believes the smoke-free work environment is the right direction to take. “But we don’t want this new policy to be punitive in nature; instead, we’re trying to be as supportive as possible.”

While policies vary slightly from business to business, the phrase ‘smoke-free work environment’ is essentially a technical term used to describe a full ban on smoking anywhere on the premises. “A true smoke-free work environment is really working toward achieving a smoke-free workforce,” said Ostrowski.

Some companies, including Mass-Mutual, have instituted somewhat less-stringent policies; smoking there, as of late 2005, is restricted to areas outside the buildings and far removed from any entrances. Meanwhile, other businesses have gone further than simple limits on where and when people can smoke, however. HNE adopted an aggressive policy that limited hiring after the ban went into effect to individuals who do not smoke. Meanwhile, both HNE and Baystate forbid employees from smoking while representing the company at any functions — anywhere, be it a conference, a holiday banquet, or a charity golf tournament.

From a legal standpoint, companies are generally on very solid ground with regards to efforts to ban or limit smoking, said Paul Rothschild, a litigator and employment specialist with the Springfield-based law firm Bacon & Wilson. That’s because, while smoking is considered an addiction, it is not a recognized handicap, and therefore it does not fall under the dictates of the Americans with Disabilities Act.

There have been a few cases filed that may test a company’s ability to limit employment to those who don’t smoke, and they bear watching, he said, but there should be no fears about banning smoking on-site.

Rothschild does, however, caution employers when it comes to formalizing policies, putting them in writing (in the company handbook), spelling out those policies to those being considered for employment, and being consistent when it comes to enforcement.

“You have to enforce these policies, like all policies, fairly and consistently,” he explained. “Otherwise, you open yourself up to trouble.”

Support System

Hopkins-Alexiadis and others we spoke with said that, of all the elements involved with going smoke-free, perhaps the most important is the support provided to employees looking to quit the habit.

Many will wait until zero-hour draws closer to get serious about quitting, she said, but a good number of those in an organization who smoke will view the pending ban as the impetus to stop. Some will try to go it alone, not wanting to make their addiction and struggle to end it public. But others will want help.

Companies have provided it through reimbursements for smoking-cessation products and programs ranging from the patch to hypnosis. At Smith & Wesson, management has gone a big step further; employees who successfully quit smoking are reimbursed their share of a year’s health insurance — $850 is roughly the average.

“That’s a policy we put in place Jan. 1, 2006, and I haven’t heard of it being done anywhere else,” said Lachenmeyer. “What that essentially means is free health insurance, except for co-pays, and we think that’s going to be a great incentive for people to quit.”

Christine Jette, Health & Wellness administrator for Big Y, said the company provides all employee smokers access to the American Lung Association’s Freedom from Smoking program.

There are five classes, with titles ranging from ‘On the Road to Freedom’ to ‘Quit Day,’ to ‘Staying Off & Let’s Celebrate.’ Those who participate in all five will be reimbursed the $25 cost of the program.

The money helps, but what most employees most need is some type of support network, said Jette, adding that the company works to provide one through its Employee Services department, which has representatives known as ESRs.

“Nicotine is addictive, it’s a drug, and Big Y could have said simply, ‘OK, quit,” she said. “But in researching this, we found that when you offer some support, people do much better.”

That support has to be organized and accessible, however, she added. “One of the positive things about this is that connection with people; when they know they can find me or one of the other ESRs and get some help and direction related to them becoming smoke-free, they’re more apt to have success.”

Both Jette and Lachenmeyer noted with some curiosity and regret how few employees at their respective companies have taken part in programs to help them quit.

Big Y, which has 9,000 full- and part-time employees in Massachusetts and Connecticut, and thus should have 1,800 to 2,000 smokers, has seen only 85 go through the ALA program; 43 of them are now smoke-free. At Smith & Wesson, which has roughly 200 smokers, the numbers are 30 and 14.

“I’m not sure why the numbers aren’t higher — maybe people are waiting until the last minute, or maybe they want to do this themselves,” said Jette. “It doesn’t sound impressive, but I still think our numbers are good. In fact, if was just one person, I would consider all this well worthwhile.”

When asked what she expects between now and July 1 and after that date, Jette said she expects more people to join the smoking-cessation programs, and overall acceptance of a new policy that will only become more common in workplaces across the country.

“I don’t think people sense that the smoke-free work environment is something that’s inevitable,” she said. “But I also believe people have to wake up, smell the coffee, and realize that this is the direction our society is moving in.”

Air Apparent

After Marie Brown’s success story was published in one of Baystate’s in-house publications, Connections, Tolosky walked down two flights at the system’s corporate offices on Chestnut Street in Springfield to pay her a visit and offer some praise.

“She’s one of our champions,” he said, adding that this term is used interchangeably with ‘hero’ to designate those who have successfully quit the habit. “I congratulated her for being bold, and brave, and open.”

These are the same qualities he attached to those companies willing to take on the assignment of creating a smoke-free work environment.

“None of this is easy … it’s very hard work,” he said. “But it’s ultimately worth it, for our organization and for the community.”