BACKGROUND-AIM:
The Dutch government aims for a smoke-free generation in 2040, defined as no smoking youth and less than 5% smoking adults. To reach this, a comprehensive package of measures and actions has been defined on four themes: 1) a smoke- and tobacco-free environment (especially for children, where tobacco products are as unattractive and inaccessible as possible), 2) effective and accessible smoking cessation care and support, 3) smoke-free organizations and 4) smoke-free healthcare. A smoke-free healthcare is of major importance because smoking and good health care do not go together, smoke-free healthcare facilities improve the health of the population and they can play a leading role in strengthening the smoke-free standard. The main objective of Dutch smoke-free healthcare is that the entire healthcare system will be smoke-free by 2030.

METHODS:
In this national implementation project, a working group has been formed with representatives from major healthcare sector organizations, such as academic hospitals, general hospitals, mental health services, addiction care, elderly care, and disability care. Representatives encourage, activate, and support the realization of smoke-free healthcare. They gather best practices and serve as a driving force for their constituents. The focus is on: 1. Smoke-free buildings and grounds 2. Healthcare professionals and other healthcare workers do not smoke during working hours and are not recognizable as smokers at their workplace 3. Healthcare professionals can, if desired, be supported in quitting smoking 4. Patients are diagnosed with any smoking behaviour and can receive active and repeated support to quit smoking 5. Healthcare professionals and staff can also work smoke-free in outpatient settings 6. Suppliers (such as taxi drivers, painters, laundries, and wholesalers) are actively reminded of the healthcare provider’s smoke-free policy on the premises 7. The smoke-free policy is promoted in all healthcare institution communications

RESULTS:
All academic hospitals, >80% of general hospitals and more than half of all mental health and addiction care facilities have a smoke-free policy implemented. Their best practices are collected on a central website https://www.rookvrijezorg.com/. For the frontrunners, it turns out to be challenging to still continue a smokefree policy after a couple of years, because new topics and points of interest arise (e.g. sustainability and employee retention). In smaller health care facilities (e.g., homes for the elderly or for the disabled), other problems prevail than in the big facilities. How about the ethical aspect of a smoking ban for permanent residents and their visitors? How to ensure a healthy working environment for care providers in their clients’ homes? During the presentation, facilitators and barriers will be discussed.

CONCLUSIONS:
It requires a tailor-made approach to find a solution in all types of health care facilities. An active working group that drives the field forward is essential.