The Just Case for 'Get-Tough' Anti-smoking Policies

While thumbing through the Internet recently I came upon a story from the Indianapolis Star about a new anti-smoking policy at Indiana University Health that extends a smoking ban for hospital employees during their off-campus break times.

The Star article called the ban “one of the most restrictive smoking policies in the nation.”

That is not accurate. Other health systems are far more aggressive. A growing number of providers, for example, have said they will no longer hire smokers, and will screen job applicants for traces of the vile weed. Now that’s restrictive! 

Sheriee Ladd, senior vice president for human resources at IU Health, tells HealthLeaders Media that the health system sees its ban as one that can be justified as patient safety issue.  

“We have told our employees that as the leading health system in the state, it is incongruent with our brand assurance to our patients and our commitment to wellness for our staff for us to continue to tolerate smoking, because of the irritants that come back into the workplace, not only for the employees but for the patients and their families,” Ladd said.

Of course, there is also an HR component at play. Employee smoking and obesity are among the biggest healthcare cost drivers for employers. If a ban on break-time smoking off-campus also encourages employees to quit smoking, everybody wins.

IU Health has discovered what many of the nation’s hospitals and healthcare providers have come to understand: They must be the tip of the spear in tobacco cessation and other broad public health initiatives.

First, as Ladd points out, it’s a patient safety issue. Second-hand smoke is dangerous. The stinky residue contains carcinogens that can prompt allergic reactions or asthma attacks among patients, their families, and coworkers. A British study last year attributed about 600,000 deaths globally each year to second-hand smoke.

Second, healthcare is a labor-intensive field. More than 14 million Americans are employed in healthcare. IU Health has 24,000 employees statewide. If a large sector of the economy that is dedicated to the well-being of others cannot take the lead controlling a huge societal cost driver for employee healthcare, who will?

Finally, healthcare sets the example for the rest of the nation to follow. It’s hard to lecture patients about the dangers of smoking, when they look out your hospital window and see a half-dozen caregivers in green scrub suits sparking up on the loading bay. Nobody should smoke -- particularly anyone who works in healthcare. They can’t plead ignorance.

All the hospital and health system executive I have spoken with who back aggressive anti-smoking policies for employees also point out that their systems offer smoking cessation classes and other help for employees who want to quit.

Health plans have medical alternatives, such as the patch.

Nicotine is highly addictive, and many smokers are hooked. To take a Zero Tolerance anti-smoking policy and firing violators without offering them the tools to quit would violate the same healing mission that the hospital is trying to protect. Smokers are not bad people. They are addicts.

At IU Health, for example, employees who violate the on-duty smoking ban are first counseled by a supervisor, given a written warning, and given a written invitation to join the hospital’s Quit For Life smoking cessation program. “If there are repeat offenses, they ultimately could be terminated, but that is just like any other policy,” Ladd says. “Our values are not that we are a mean-spirited organization but we are saying to our employees this isn’t helping our patients. It’s not safe. And you can’t do that to our patients.”

In previous columns I have questioned the right of employers to dictate what employees can do on their own time. And – justified as it may be as a matter of health and economics -- I am still very uneasy with the idea of removing smokers as job candidates. Smoking tobacco is legal. And if banning people for using a legal product is done in the name of controlling health insurance costs, then the slippery slope argument begs the question, what’s next? Bans on pizza and beer after work? Will diabetics be the next class of workers to be banned from the workplace? After all, much of Type 2 diabetes is related to diet, which is a lifestyle choice.

The distinction with smoking cessation that should be made for the healthcare sector is the very nature of the healing mission. Healthcare can make the case that employees who smoke directly and negatively impact the people they are hired to serve. 

IU Health has it right. Promoting smoking cessation in hospitals and in the provider community is a patient health issue. That by itself is a strong enough justification. The fact that it will also improve employee health, and quality of life, and lower employee healthcare costs is a bonus.

But, they are also separate issues.