Going 100% smoke-free in a secure setting: one hospital's successful experience

When the Mental Health Centre in Penetanguishene, Ontario, announced that the use of tobacco products would no longer be allowed anywhere on its 225-acre grounds after May 6, 2003, many patients and staff reacted with disbelief. In this article, the authors discuss the operational, health and safety, clinical and ethical issues surrounding the decision.     

Smoking in Boston bars before and after a 100% smoke-free regulation: an assessment of early compliance.

The objective of this study was to assess compliance with Boston's 100% smoke-free bar regulation within the first 3 months of implementation. An observational survey was conducted of a random sample of 102 bars in Boston before and after the smoking ban went into effect. Forty bars were observed both pre- and postban, serving as a true comparison group; 62 additional bars were observed postban only. From preban to postban, highly significant decreases were found in the mean proportion of patrons smoking inside (22.5% to 0.19%, p < 0.0001), in the proportion of bars with smoking patrons (100% to 2.5%, p < 0.0001), and in the average number of ashtrays present in each bar (24 to 0, p < 0.0001). A highly significant increase was found in the average number of "no smoking" signs posted in each bar (0 to 3.3, p < 0.0001). Within the 3 months immediately following the 100% smoke-free bar regulation in Boston, bars were highly compliant with the ban, including not allowing patrons and employees to smoke, removing ashtrays, and posting signs indicating that smoking is prohibited. Therefore, with proper time and preparation, public health practitioners can change social norms before a ban goes into effect and can implement smoke-free policies smoothly and with immediate compliance.     

Redesigning a national healthcare system: the Israeli experience

In 1988 the Government of Israel appointed a Commission of Inquiry (of which the authors were members) to examine the state of its health-care services. Although relating to Israel, some of the problems contributing to the crisis in the health services are shared by other industrialized nations. In 1991 the findings and recommendations of the Commission were adopted by the Government. They related to the major problem areas analysed by the Commission: poor standard of service to the public; health ministry structure and performance; funding and budgeting; poor labour relations in the public health sector; surplus of physicians; mix of public and private health care; shortage of qualified health-care managers. The main recommendations adopted were: legislation for compulsory health insurance (due to be effective on 1 January 1995), establishing a National Health Authority, running of hospitals by autonomous corporations and reform in salary structure.     

Cigarette use by college students in smoke-free housing: results of a national study

BACKGROUND: Cigarette-smoking rates have increased in recent years among college students. Smoke-free residences offer a possible means of reducing or preventing smoking. However, their use has as yet not been evaluated. This paper examines whether students residing in smoke-free residences are less likely to smoke cigarettes than students in other campus residences, and if such lower rates apply to all types of students and colleges. METHODS: The Harvard School of Public Health College Alcohol Study surveyed a nationally representative sample of college students at 128 U.S. 4-year colleges regarding tobacco use and related behaviors in the spring of 1999. The responses of students living in smoke-free and unrestricted residences at 101 campuses were compared. RESULTS: Current smoking prevalence was significantly lower among residents of smoke-free housing (21.0%) as compared with residents of unrestricted housing (30.6%, p<0.0001). The lower rate of current cigarette use was consistent with all types of student and college characteristics with few exceptions. Current cigarette use was significantly lower for those living in smoke-free housing than for residents of unrestricted housing among students who were not regular smokers before age 19 (10% vs 16.9%, p<0.0001), but not among students who smoked regularly before age 19. CONCLUSIONS: Smoke-free residences may help protect those students who were not regular smokers in high school from smoking in college. However, the difference in smoking rates may be due to self-selection of students into smoke-free residences. Since smoke-free options also protect students from second-hand smoke and dormitory fires, colleges should provide these types of residences for all students who request them, and should also encourage others to choose them.     

Work life and patient safety culture in Canadian healthcare: connecting the quality dots using national accreditation results

Fostering quality work life is paramount to building a strong patient safety culture in healthcare organizations. Data from two patient safety culture and work-life questionnaires used for Accreditation Canada's national program were analyzed. Strong team leadership was reported in that units were doing a good job of identifying, assessing and managing risks to patients. Seventy-one percent of respondents gave their unit a positive overall grade on patient safety, and 79% of respondents felt that they could often do their best-quality work in their job. However, healthcare workers felt that they did not have enough time to do their jobs adequately and indicated that co-workers were cutting corners in patient care in order to save time. This article discusses engaging both senior leadership and the entire organization in the change process, ensuring supervisory support, and using performance measures to focus organizational efforts on key priorities all as improvement strategies relevant to these findings. These strategies can be used by organizations across sectors and jurisdictions and by healthcare leaders to positively affect work life and patient safety.     

Mergers of healthcare facilities: impact upon materiel management

Hospital mergers afford healthcare providers the chance to take advantage of economies of scale, integrate clinical, administrative and support functions, eliminate functional redundancies and redesign patient care delivery. This article explains how such advantages were realized, demonstrated through a hypothetical case based on information obtained from actual mergers. A corporate materiel management division was established, and centralized warehousing, product evaluation and purchasing instituted. Some management positions were eliminated or restructured and patient care services were closed, relocated, or opened among the various entities in the merger. Through these and other changes, the new healthcare system was about to realize about $1.7 million in one-time savings and expects savings in the seven digits over at least the next three years. The article concludes that as hospital mergers continue to increase, the position of corporate director of materiel management will evolve as the next logical career step for materiel management professionals.     

Disaster planning and response: guidance for healthcare facilities

The widespread devastation and massive disruptions caused in the last few weeks by Hurricanes Katrina and Rita--in New Orleans and numerous other communities along the U.S. Gulf Coast--showed just how difficult it can be for communities to function in the face of large-scale disasters. In the wake of these storms, healthcare facilities throughout the world will undoubtedly be examining their emergency management plans to assess whether they are prepared to handle similar events.     

Developing a program for dealing with violence in healthcare facilities

The potential for violence is a growing concern in all healthcare facilities. Violent acts may be perpetrated by visitors, patients, employees, or outsiders. There are no simple answers to preventing or defusing such violence, but greater attention to the total climate for violence and a realistic approach to treating its different aspects are essential. In this report, Fredrick Roll, executive vice president, Hospital Shared Services, Denver, CO, which provides security services for more than 140 hospitals in six states, discusses the different aspects of violence that must be considered by all hospitals when setting up programs to deal with the problem.