The hardline proposals, put forward by Sandwell and West Birmingham NHS Hospital Trust, would see smokers confined only to smoking 'shelters' for three years – before a total ban on taking a drag is introduced in 2018.
Trust board members discussed their options on how to tackle smokers inhaling in and around hospitals at a meeting on Thursday.
The smoking shelters would be the only place smokers can puff away in the first instance and if they are caught doing so anywhere else they would be slapped with a fixed penalty notice.
The trust aims to introduce a new policy next year at its hospitals – Sandwell General, City and Rowley Regis – before bringing in the zero tolerance ban at all sites when the new Midland Metropolitan Hospital opens in 2018.
"No cigarettes will cross the threshold of that hospital – not even in the car park.
This would apply to all staff, visitors and patients, and smokers would be given advice and help on how to quit.
Members were in agreement that the staged plan – starting with the shelters and penalty notices and then bringing in the total ban in three years – would provide the best chance of tackling the underlying issues around smoking.
Chief nurse Colin Ovington said: "Having a staged approach to try to get people to stop smoking is the right thing to do morally."
The board also discussed whether e-cigarette users should be treated the same way as normal cigarette smokers.
As research into the effects of e-cigarettes is not yet comprehensive, creating a 'semi-detached' shelter for both e-cig and normal cigarette smokers was suggested.
This would stop e-cigarette smokers inhaling smoke from cigarettes.
The board members agreed a decision in principle to bring in the shelters early next year and then start its zero tolerance crackdown on all smoking in 2018. This will be confirmed at its next meeting in December.
They plan to wait for more research into the harm of e-cigs before making a decision.
Chief executive Toby Lewis said: "If we can cohort people in shelters then we can target support at them. That gives our staff and visitors who smoke a period of three years of support.
"A Fixed Penalty Notice gives us a remedy, as opposed to simply saying 'you shouldn't be doing this' then walking away."