Pennsylvania Health Care Worker Flu Immunization Campaign A Patient Safety & Employee Health Initiative Training Resources: Cast Study Module: Abington Memorial 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 Abington Memorial Abington Memorial Hospital (AMH) is a 665-bed, regional referral center and teaching hospital, which has been providing comprehensive, high-quality services for people in Montgomery, Bucks and Philadelphia counties for more than 90 years. AMH employs over 5,600 employees, making AMH one of the largest employers in Montgomery County. The hospital’s medical staff consists of over 900 physicians, including primary care, medical and surgical specialists. More than 1,100 volunteers give their time and talents to support this not-for-profit hospital, and AMH provides more than $45 million in free care to our community each year. Contacts: Debra Miller, RN, BS, CIC Director Infection Control Abington Memorial Hospital Robin Piccinini RN-BC, COHN Administrative Manager Employee Health & Occupational Health Services Abington Memorial Hospital Bonnie Grassey, RN, CIC Infection Control Nurse Abington Memorial Hospital

Case Study Snapshot Abington Memorial Overview After averaging seasonal vaccine uptake among its HCWs and care community of about 50% for several years (best performance at 68%) despite active annual campaigns, Abington adopted a mandated program for the flu season, achieving a 99.34% uptake. Seasonal Influenza Vaccine Uptake Pre-mandate Post-Mandate ≈ 50% 99.34%

Case Study Snapshot Abington Memorial Program Justification Primarily positioned as a patient safety initiative which involved entire Abington community, with the additional dimension of an employee safety initiative. Program Details - establishes seasonal flu vaccination as a condition of employment - impacts all employees, volunteers, students, vendors - impacts non-employee professional staff (privilege suspension) - integrates medical exemptions (reviewed by medical committee) and religious exemptions (reviewed by diversity committee): very low incidence rate Key Champion(s) Dr. Jack Kelly, Chief of Staff; Head, Infectious Disease - drove the initial decision and implementation across leadership structure and functions

Case Study Snapshot Abington Memorial Timeline Jan-Feb /2010 seasonal flu vaccination campaign data summarized: performance below acceptable levels; decision to explore mandated program April 2010: - Infection Control, Employee Health and Public Relations meet to discuss logistics of a mandatory program July 2010: - Meeting of Abington senior leadership group to review issues and approve implementation including: CEO, COO, COS, HR, Public Relations, IS, Legal, Employee Health, Infection Control August 2010: - Review and approval by Medical Executive Committee and Board of Trustees September 2010: - Formal launch to all stakeholders with blanket communications - Season flu vaccination campaign “beefed up” in first year with one-to-one counseling, “healing room” for needle fear, rounding support++ April Thank you letter from Chief of Staff Jack Kelly to Abington community

Case Study Snapshot Abington Memorial Key Strategies/Success Factors - Collaborative engagement of Abington leadership across functions/disciplines - Universal requirements from trustees to all employees, to non-employee professional staff to student and volunteers to vendors - Blanket communications to all stakeholders: town meetings, newsletter, website++ Leadership Team (functions that made it happen) Chief of Staff, COO, CNO, Legal, HR, Finance, Marketing, Infection Control, Occupational Health

Case Study Snapshot Abington Memorial Best sound bite(s) From April 2011 thank you letter from Chief of Staff Dr. Jack Kelly to Abington community after successful first program cycle: “…The influenza vaccination campaign was an extraordinary success. Certainly for those fearful of vaccination for any reason, as well as those who held a belief that they have never gotten the flu, the concept of a “mandatory” flu shot was upsetting. A commitment by the “flu team” to counsel and educate on the “evidence,” often individual, couple with your strong sense of duty carried the day: greater than 99% of all employees of Abington Health and its Active Medical Staff received the vaccine. The delta between the latter percentage and 100% represents the very small number of medical and religious exemptions granted. Two employees out of nearly 7,000 employees, volunteers, medical staff and Trustees chose to separate from Abington Health rather than receive the vaccine…”

Case Study Snapshot Abington Memorial Additional Perspectives Points of Contention Around Mandate/Exemptions Requests for exemption - Religious – all requests to be submitted on church letterhead and then investigated by Diversity/Legal - Ethical reasons – not accepted, counseling offered - Fear – not accepted, but soothing environment provided - Egg allergy – required allergy testing - Pregnancy – not accepted, counseling offered - Constitutional rights – handled the same as religious exemption Non-employed Physicians, Residents and students - Held to same standard as employees Vendors - Required to provide proof of vaccination through electronic vendor software Condition of employment - All new employees vaccinated on hire through June (vaccine expiration)

Group Exercise  What strategies from the Abington case study might work well in your institution? Why?  What parts of the Abington 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 Abington experience? We will use observations and answers to build a collection of “frequently-asked-questions” (FAQs) for the website