Pennsylvania Health Care Worker Flu Immunization Campaign A Patient Safety & Employee Health Initiative Training Resources: Cast Study Module: Geisinger Version 1.1 June 2011

Case Study Modules  Based on interviews with leaders at institutions representing best and promising practices  Focus on common elements of strategy, decision to implement programs, internal support and barriers  Focus on mandatory programs given policy and ethics foundations  Recognition that each institution is unique, but overall goal (90%+ uptake) is patient safety/ employee safety imperative is same everywhere!

Case Study Snapshot Geisinger Health System Founded in 1915, Geisinger is a physician-led health care system, dedicated to health care, education, research and service spanning 43 counties of 20,000 square miles and serving 2.6 million people. Geisinger employs about 11,000. Geisinger’s vision is based on these guiding themes - Quality: providing superb care across the organization - Value: providing care where and when it is needed - Partnerships: working collaboratively with other providers, businesses, and educational institutions - Advocacy: championing causes for improving rural health. Contacts: Lisa M. Esolen, MD Systems Director, Infection Control (570) (phone) Kimberley Kilheeney (570)

Case Study Snapshot Geisinger Health System Overview Geisinger has implemented a hybrid solution over two seasons which combines a strong, flu-team model (150 strong) empowered with vaccine, information and enthusiasm to drive uptake, combined with a mandatory, rigorous six-month masking policy for HCWs who decline or cannot (medical) be vaccinated. The masking strategy proceeds in part from a view that annual mandatory vaccination required a different strategy than other HCW vaccination requirements. Geisinger stresses that it is not against mandated vaccination in principle as it has implemented a mandatory pertussis vaccination policy in parallel with the masking strategy. Seasonal Influenza Vaccine Uptake Pre-mandate Post-Mandate* ≈ 60% 95-97% *mandate: medical or other declination = mask from November 1 to March 31

Case Study Snapshot Geisinger Health System Program Justification Positioned as a patient safety imperative – infection control. Program Details - establishes HCW seasonal flu vaccination as a system-wide imperative - uses 150 Flu Team Captains across system with training and kit (vaccine, info, consent forms) - uses manager updates on uptake performance - employs annual campaign-themed stickers for employee ID badges - mandated masking for all employees who have medical issues or elect personal declinations; masking runs from November 1 through March 31 - applies to all employees, volunteers, students, vendors - applies to non-employee professional staff and system leadership - medical declinations limited to egg allergy with referral to allergist; personal/religious declinations unchallenged but invokes masking - strong oversight of masking: must be masked within five feet of any human; stickers on ID badge; warning letters in stages then suspension/separation - achieved 96%+ uptake within six weeks

Case Study Snapshot Geisinger Health System Key Champion(s) - CEO/CMO - Infection Control and Occupation Health Leadership Team (functions that made it happen) Infection Control, Occupational Health, HR, Communications Key Strategies/Success Factors - Wide, early communications across community - Physician leadership critical to success - Empower flu team captains (150) with actual vaccines, information, consent forms, goals…build organization-wide enthusiasm - Use tracking system to generate internal reports for local manager action/follow-up - Policing of masking requirement critical (can’t be a paper tiger!): suspension action

Case Study Snapshot Geisinger Health System Best sound bite(s) Key question: Will we fire the highest revenue producing surgeon if they do not comply with either masking or vaccination? Answer: Yes [A doc challenged the requirement and a formal letter was generated within days offering the option of compliance or suspension] New! Journal of Infection Control and Hospital Epidemiology Published online Jun 1, 2011: An Alternate Approach to Improving Healthcare Worker Influenza Vaccination Rates Lisa M. Esolen, Kimberly L. Kilheeney, Richard E. Merkle, Albert Bothe An Alternate Approach to Improving Healthcare Worker Influenza Vaccination Rates Abstract Optimizing employee influenza vaccination rates has become a healthcare focus. We detail an approach involving a strong requirement for unvaccinated workers to wear a face mask and a superconvenient vaccination process. Our major teaching hospital achieved 95% compliance in 2009, and our health system reached 90% and 92% compliance for 2 years.

Group Exercise  What strategies from the Geisinger case study might work well in your institution? Why?  What parts of the Geisinger experience would NOT work for your institution? Why?  What barriers do you see within your institution moving towards a mandatory program?  Which barriers are not addressed in the Geisinger experience? We will use observations and answers to build a collection of “frequently-asked-questions” (FAQs) for the website