A large 2-campus Medical Center in Western New York, along with several other large area hospitals, planned for and simultaneously implemented successful "Smoke-Free Campus" initiatives in November of 2006. This coordinated initiative required that each system plan accordingly for the development and implementation of policies, training of employees, clinicians, support staff and provision of tobacco treatment services (directly or via referral). In order to efficiently and competently inform each of these aspects of a system-wide initiative, accurate information was needed on the prevalence of tobacco use among employees, staff, faculty, and clinicians in each system. A multi-system surveillance initiative was implemented, using a brief survey for all employees of several of the partnering institutions. Summary data from the baseline measures are discussed. Also presented are Lessons Learned from the year-long planning and implementation phases, including details on topics categorized by the specific sub-committees that coordinated each area (e.g., Policy and Procedure, Communication, Faculty/Staff/Student Issues, Patient Issues (Inpatient and Outpatient), Tobacco Dependence Treatment and Provider/Staff Training). The effort was effective in instituting system-wide changes in all of the participating hospitals in the greater metropolitan area. A community-wide consortium convened each month for a year, and subcommittees within each hospital allowed planners to break up the initiative into manageable pieces. The extended timeline of 1 year was appropriate for overcoming fears, biases, and barriers which then enabled "buy-in" and support from leadership as well as employees.