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Hospital mandates influenza vaccinations
Launched in 2004 to controversy and the threat of lawsuits, Virginia Mason Medical Center's (VMMC) mandatory influenza vaccine policy has been named the best in the country among health care immunization programs.
The National Influenza Vaccine Summit, an arm of the Centers for Disease Control and Prevention (CDC) and the American Medical Association (AMA), gave the Seattle medical center its award for excellence in health care immunization for achieving a 98% immunization rate among everyone working at the site — all employed staff and other individuals working in its facilities, including community physicians, vendors, volunteers, and contingent labor.
"We are delighted to be recognized for our efforts to protect our patients, our staff, and their families," says Patti Crome, RN, MN, CNA, FACMPE, senior vice president and clinic administrator at VMMC and part of the Virginia Mason flu team. Recognizing that other hospitals have met with varying degrees of success in getting employees to get flu shots, the center's employee health supervisor, Beverly Hagar, BSN, COHN-S, shared the program's history and tips for success with Occupational Health Management. Health care workers are among those groups that the CDC recommends receive annual influenza vaccine. (See box, below.)
Persons for Whom Annual Influenza Vaccination is Recommended
Source: Centers for Disease Control and Prevention, Atlanta.
Introducing a different plan
Hagar says VMMC was the first vertically integrated health care delivery system in the country to successfully implement an influenza immunization fitness-for-duty (i.e., mandatory) policy.
"The policy affects all employed staff and other individuals who work in our facility, including community physicians, vendors, volunteers, and contingent labor," says Hagar. "This ground-breaking work began as an idea generated from front-line staff, further developed during a Rapid Process Improvement Workshop [RPIW], and then grew into an innovative, organization-wide initiative supported by physician and administrative executive leadership and the board of directors."
Once the idea was adopted in principle, Hagar says, feedback was solicited from management and staff. "Comprehensive change management methods were utilized to engage the organization," she explains. "Management and staff meetings occurred during which there were open forums to discuss the program. Teams utilized Edward DeBono's 'Six Hats' discussion techniques to gather input and involve as many staff as possible." (See resources at the end, for more information.)
VMMC fully implemented its influenza immunization fitness-for-duty policy in 2005 and 2006. In the program's first year, the center fielded legal action by the state nurses' union, which filed suit in federal court seeking to stop the vaccination program. The program was further hindered by a vaccine shortage that left VMMC with only about one-quarter of the vaccine it needed for a full program. Hagar says the medical center kicked off its campaign with a tailgate party featuring members of the Seattle Seahawks pro football team and "fueled by popcorn, bratwurst, and soft drinks." Seven hundred of VMMC's nearly 5,000 employees were vaccinated during the event.
In other efforts to promote vaccination, staff engaged in a "Name the Campaign" contest, in which they submitted slogans for the campaign. The winning slogan — "Save Lives — Immunize!" — was printed on bracelets and lanyards given out at vaccination clinics. The flu team developed a teaching video that used humor and personal stories from VMMC staff to emphasize the importance of flu immunizations in keeping patients, staff, and the community safe from widespread flu. Nurse and physician "flu champions" were designated to educate staff one-on-one.
Other campaign features included:
"One of the things we found to be challenging was debunking the myths around influenza immunization, such as, 'The flu vaccine gives you the flu,' and mercury issues, etc.," recalls Hagar. "We launched an educational campaign to address these many issues."
(Editor's note: The American Lung Association offers a list of some commonly held myths about influenza, at its prevention web site, www.facesofinfluenza.org. Under "Professional Health Info," click on "For Health-Care Providers," and then scroll down to and click on "Myths about Influenza Fact Sheet.")
Accommodations, not declinations
Declination forms, a point of contention at some hospitals where staff felt singled out by the forms, are not used in Virginia Mason's program. "We did not use the written declination system. We did provide an accommodation process, where individuals submitted an accommodation form to a committee who reviewed individual requests for medical and religious accommodations," Hagar explains. "Individuals who were accommodated had to use a mask for the duration of the flu season."
The Washington State Nurses Association (WSNA) has objected to the VMMC policy from the beginning. The WSNA advocates for all health care workers to be immunized, but it is against mandating the shots as a condition of employment. In a letter to VMMC nurses in January,1 WSNA labor relations director Barbara E. Frye, BSN, RN, wrote that the court battle continues over the immunization program and the requirements that accommodated employees wear masks. "[We] are awaiting a trial or decision by the court." "In the mean time, the hospital cannot force any registered nurse to take a flu shot against their will."
However, the National Labor Relations Board has ruled that the hospital can require that those who don't receive the vaccine shot to wear masks, Frye told nurses. "We hope to get this ruling overturned," she added.
Hagar, however, says the vaccination program "has set a solid foundation for our medical center's annual influenza immunization efforts and for the safety of our many constituencies — patients, staff, and visitors.
"Virginia Mason was able to provide 100% protection through this program and we plan to continue these efforts. The medical center set an example of what is possible, and we would encourage other organizations to look at a program around mandatory."
1. Barbara Frye, in letter to Virginia Mason Medical Center nurses, Jan. 18, 2007. Web: www.wsna.org/localunits/virginiamason.asp.
For more information on influenza vaccine programs: