Creating a smoke-free environment in a medical center: an overview.

Beth Israel Medical Center committed itself to a smoke-free environment on May 7, 1987 after seven months of careful study by a policy determination committee and, thereafter, seven months of meticulous planning for its announcement and implementation. The policy rests on two premises: passive smoking is harmful to nonsmokers; a medical center "employer," above all others, has a special, impelling obligation to shield persons in its environs from such exposure. The impetus came from the medical staff. The policy acceptance and commitment had the combined approval of the medical staff, administration, and trustees. The ban applies to all who serve, are served in, or otherwise visit the Center. Care was taken to prepare all staff and patients for the stringent policy effective May 7, 1987. Its medical basis was made clear. Support was arranged for smokers who were interested. Response in the first year and a half has been increasing acceptance, which reflects careful preparation as well as in depth support from the medical staff. Problems are met with discussion and reasoning, not punitively.