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Carrots and Sticks: Achieving High Healthcare Personnel Influenza Vaccination Rates without a Mandate

Published online by Cambridge University Press:  27 February 2015

Marci Drees ,
Kathleen Wroten ,
Mary Smedley ,
Tabe Mase  and
J. Sanford Schwartz
Marci Drees*
Affiliation:
Department of Medicine, Christiana Care Health System, Wilmington, Delaware Department of Infection Prevention, Christiana Care Health System, Wilmington, Delaware Department of Medicine, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania Value Institute, Christiana Care Health System, Newark, Delaware
Kathleen Wroten
Affiliation:
Department of Infection Prevention, Christiana Care Health System, Wilmington, Delaware
Mary Smedley
Affiliation:
Department of Employee Health Services, Christiana Care Health System, Wilmington, Delaware
Tabe Mase
Affiliation:
Department of Employee Health Services, Christiana Care Health System, Wilmington, Delaware
J. Sanford Schwartz
Affiliation:
Perelman School of Medicine, Wharton School of Business and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
*
Address all correspondence to Marci Drees, MD, MS, Christiana Care Health System, Department of Medicine, Suite 2E70, 4755 Ogletown-Stanton Road, Newark, Delaware 19718 (mdrees@christianacare.org).
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Abstract

OBJECTIVE

Achieving high healthcare personnel (HCP) influenza vaccination rates has typically required mandating vaccination, which is often challenging to implement. Our objective was to achieve >90% employee influenza vaccination without a mandate.

DESIGN

Prospective quality improvement initiative

SETTING AND PARTICIPANTS

All employees of a 2-hospital, 1,100-bed, community-based academic healthcare system.

METHODS

The multimodal HCP vaccination campaign consisted of a mandatory declination policy, mask-wearing for non-vaccinated HCP, highly visible “I’m vaccinated” hanging badges, improved vaccination tracking, weekly compliance reports to managers and vice presidents, disciplinary measures for noncompliant HCP, vaccination stations at facility entrances, and inclusion of a target employee vaccination rate (>75%) metric in the annual employee bonus program. The campaign was implemented in the 2011–2012 influenza season and continued throughout the 2012–2013 through 2014–2015 influenza seasons. Employee compliance, vaccination, exemption and declination rates were calculated and compared with those of the seasons prior to the intervention.

RESULTS

Compared with vaccination rates of 57%–72% in the 3 years preceding the intervention, employee influenza vaccination increased to 92% in year 1 and 93% in years 2–4 (P<.001). The proportion of employees declaring medical/religious exemptions or declining vaccination decreased during the 4 years of the program (respectively, 1.2% to 0.5%, P<.001; 4.4% to 3.8%, P=.001).

CONCLUSIONS

An integrated multimodal approach incorporating peer pressure, accountability, and financial incentives was associated with increased employee vaccination rate from ≤72% to ≥92%, which has been sustained for 4 influenza seasons. Such programs may provide a model for behavioral change within healthcare organizations.

Infect Control Hosp Epidemiol 2015;00(0): 1–8

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 36 , Supplement 6 , June 2015 , pp. 717 - 724
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

PREVIOUS PRESENTATION. These data were presented in part at the ID Week conference, San Diego, CA, on October 18, 2012.

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