Countdown to Flu Shot Compliance Begins

Encouraging healthcare workers to get their flu shots has been a patient safety and quality of care issue for years. Mandatory public reporting of this hospital quality measure is finally moving the needle.

On October 1, while everyone was buzzing about whether or not they could get past the technical glitches on health insurance exchanges, the 2013–2014 flu season officially began.

This year flu season is different. This year, it's not only hospitals, but acute care and long term care facilities that must report staff vaccination rates to the Centers for Medicare and Medicaid Services or risk being penalized. The data will be posted on Hospital Compare.

Last flu season, 72% of healthcare personnel reported having had a flu vaccine, a 5.1 percentage point increase from the 2011–2012 season. Hospital-based employees had the highest vaccination rate (83.1%) and long-term care employees had the lowest vaccination rate (58.9%).

For North Shore-LIJ Health System's more than 46,000 employees in hospitals across Queens, Staten Island, Long Island and Manhattan, federal reporting appears to have helped improve vaccination rates.

During the 2012–2013 flu season, 68% of the staff at North Shore-LIJ were vaccinated, 27% declined, and 1% were medically exempt. In the 2011–2012 flu season, 58% were vaccinated, 16% declined, 0% were medically exempt, and the status of 26% of employees was unknown.

Infrastructure Matters
Because of the CMS reporting requirement, North Shore-LIJ had to make a big push to document the status of its employees. Lorraine Chambers Lewis, assistant vice president of employee health services at North Shore-LIJ, says NSLIJ's intranet infrastructure was essential to effectively tracking and tallying their compliance with CMS's new rule.

"If you don't have the infrastructure already there, this is extremely difficult. The data gives the leaders the information and gives the department heads and managers something to react to in order to engage folks. Without it you don't really know where you are. The data is so important," Lewis says.

The intranet reports allowed managers to know exactly where their direct reports stood with regard to the flu vaccine. Lewis attributes this level of individual accountability for increasing the health system's vaccination rate by 10 percentage points.

"Human resources played an extremely important role in making this happen. They were a critical aspect from compliance and communicating to managers. Questions and concerns about compliance all went through HR, as well as the strategies to make sure compliance happens overall. That's how we got to 96% reporting their status last year," Lewis says.

Last year, there were some concerns at North Shore-LIJ about pockets of employees who traditionally had low vaccination rates. Nationally, different cultural groups perceive vaccinations differently. For example, CDC data for the past three years shows that vaccination rates for non-Hispanic whites were higher than for non-Hispanic blacks, Hispanics, and adults of other or multiple races.

At North Shore-LIJ, a task force enlisted the help of the diversity officer to make sure those employees had background and education on what's available, why it's important for their health, as well as the safety of the patients.

Strategy Shift to Top-Down Team Approach
"We tried to make sure we address those folks' concerns and discuss any cultural issues that might exist," says Lewis. "We really wanted to make sure we addressed the needs of anyone. If any group was very hesitant, we wanted to be sure we could engage with them."

Running through each of these elements was the key strategy shift: Engage a top-down team approach. Executives at all the North Shore-LIJ sites leaders were held accountable with the data before them. They enlisted and empowered their managers with this data as well to ensure that system-wide communications were reaching the individual employees.

"The main message was, 'We all care. About your health and well being, as well as our patients.' The goal for the strategy was that for every employee, someone is speaking to you and reaching out to you. To do that we had to have educated and enlisted managers," says Lewis.

This year North Shore-LIJ started its employee campaign to get workers vaccinated in early September. One month later, 53% are vaccinated, 3% have declined, and 0% have reported a medical exemption. With 56% participating so far, the health system is way ahead of where it was last year.

It looks like it does take a little bit of mandating to create lasting change. Especially when needles are involved.