“Smoke-Free SFMC” Project, St. Francis Medical Center, Lynwood, CA Established in 1945, St. Francis Medical Center was the only comprehensive, nonprofit healthcare institution serving Southeast Los Angeles. The medical center operates a 384-bed acute care hospital, busy private emergency and Level II trauma centers, family life center with state-of-the-art neonatal intensive care, health benefits resource center, and children’s counseling center. In addition, SFMC sponsors a behavioral health service line with a 40-bed locked acute behavioral health unit

(BHU), outpatient psychiatric services (OPS), and a psychiatric evaluation team (PET)

for psychiatric crises. Over $10,000 per year was spent by the medical center to purchase cigarettes for psychiatric inpatients.

SFMC provides quality medical care, educational programs, school-linked health services, and support services to the 1,000,000 residents of communities in Southeast Los Angeles County. Within service planning areas (SPAs) 6, 7, and 8, which encompass the major communities within SFMC’s service area, Hispanics are the largest [growing] ethnic group at 56.8%, followed by Whites at 16.3%, and African Americans at 13.0%, according to U.S. Census Bureau and American Community Survey 2010 statistics (https://www.census.gov/quickfacts/fact/table/

US/PST045221).

Based on the most recent data from the Los Angeles County Department of Public Health, from 2000 to 2009, the leading causes of mortality in Los Angeles County were coronary heart disease, stroke, lung cancer, emphysema, and Alzheimer’s. In SPAs 6, 7, and 8, coronary heart disease was also the leading cause of death. Compared to the other SPAs and the county, SPA 6 has the highest percentages of adults living with one or more chronic health conditions. Overall, Southeast Los Angeles residents suffer from significant risk factors associated with cardiovascular disease, such as hypertension, diabetes, high cholesterol, and smoking.

Smoking is a controllable risk factor, and EBP shows that smoking cessation is effective in lowering risk, reducing complications of chronic illness, and improving quality of life. According to the report, “Cigarette Smoking in Los Angeles County:

Local Data to Inform Tobacco Policy" (Los Angeles County Department of Public Health, Office of Health Assessment and Epidemiology, 2010) produced by the Office of Health Assessment and Epidemiology at the County of Los Angeles Public Health Department, all the communities served by SFMC are at the third or fourth quartile for prevalence of smokers (Los Angeles County Department of Public Health, Office of Health Assessment and Epidemiology, 2009). This equates to nearly 115,000 estimated smokers in the communities located in SFMC’s primary service area. According to the Los Angeles County Department of Public Health, Office of Health Assessment and Epidemiology (2015), 13.3% of adults smoke cigarettes. Tobacco use in the county is lower than the national average of 19%, but remains slightly above the Healthy People 2020 target of 12% or fewer adults using tobacco (HealthyPeople.gov, n.d.).

■ Approximately 8,600 lives and $4.3 billion are lost due to medical care and lost productivity costs associated with smoking and smoking-related diseases in Los Angeles County each year.

■ The leading causes of smoking-related death are lung cancer, coronary heart disease, and chronic obstructive pulmonary disease (COPD).

■ Of households with children, 17% report tobacco smoke exposure in their homes

(Los Angeles County Department of Public Health, Office of Health Assessment and Epidemiology, 2015).

The medical center, situated on a 121-acre campus, including the medical office building, progressive care unit (housing the behavioral health service line), and children’s counseling center (two sites), decided to go completely smoke-free for patients, visitors, employees, medical staff, and volunteers within 6 months of starting a health and wellness journey. This unbudgeted initiative to improve the health outcomes of the community required a massive culture and systems change. A grant was available from Los Angeles County for $5,000 per site to implement smoke-free policies and practices. The deliverables specified by the grantor were:

■ Develop a smoke-free policy and achieve a smoke-free campus.

■ Develop and implement smoking-cessation protocols.

■ Purchase signage.

■ Participate in educational webinars and monthly conference calls (two people per site).

■ Consent to technical site visits by government officials.

The hospital foundation did not have a grant writer available for a small grant;
however, a DNP student working at the medical center needed to write a grant project for class. The grant application was due 30 days from the time the DNP student became aware of its existence.

a. What steps does the DNP student need to take to leverage this grant opportunity in a short submission time frame?

b. What grant components should be included in the grant framework?

c. What resources may exist from the grantor; medical center; community, state, and/or nation to maximize the economics for the unbudgeted “Smoke-Free SFMC” initiative?

d. How can the numerous departments and service lines on the campus be leveraged to increase the grant award?

e. Who does the DNP student need on the grant planning, writing, and executing team?

f. How will outcomes be measured for the various populations (patients, visitors, employees, medical staff, and community) impacted by the grant tactics?