1. Pennsylvania Health Care Worker Flu Immunization Campaign A Patient Safety & Employee Health Initiative Training Resources: Cast Study Module: CHOP Version 1.2 June 2011

2. 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!

3. Case Study Snapshot Children’s Hospital of Philadelphia (CHOP)
Children’s Hospital of Philadelphia Since its start in 1855 as the nation’s first hospital devoted exclusively to caring for children, The Children’s Hospital of Philadelphia has been the birthplace for many dramatic firsts in pediatric medicine. The Hospital has fostered medical discoveries and innovations that have improved pediatric healthcare and saved countless children’s lives. Over 150 years of innovation and service to our patients, their families and our community, reflect an ongoing commitment to exceptional patient care.
Contacts: Susan Coffin, MD, MPH; Hospital Epidemiologist and Medical Director, Infection Prevention & Control ( ) Mary Cooney, RN; Nurse Manager, Occupational Health ( )

4. Pre-mandate Post-Mandate
Case Study Snapshot Children’s Hospital of Philadelphia (CHOP)
Overview After averaging seasonal vaccine uptake among its targeted clinician group of about 90% with very active campaigns, CHOP decided to both expand its target populations beyond clinicians, and instituted a mandated program for the flu season for all persons who work in buildings where clinical care is delivered, achieving 100% uptake across its 9,500 person community.
Seasonal Influenza Vaccine Uptake
    Pre-mandate                                          Post-Mandate
≈ 90%*                           100%**
                                             
*clinician population target                        **overall population

5. Case Study Snapshot Children’s Hospital of Philadelphia (CHOP)
Program Justification Positioned as a patient safety imperative.
Program Details - establishes seasonal flu vaccination as a condition of employment - impacts all employees, volunteers, students, vendors - impacts non-employee professional staff (university appointments at Penn) - grants exemptions based on standardized review process: medical – reviewed by medical committee if physician documentation falls outside traditional exemption categories/physician follow-up; religious – reviewed by outside independent party (retired judge): very low incidence rate
Key Champion(s) Infection Control and Occupation Health

6. Case Study Snapshot Children’s Hospital of Philadelphia (CHOP)
Timeline Early 2009: - Review of 2008/2009 seasonal flu vaccination campaign performance; discussed potential to proceed to mandated program
April/May 2009: - Hospital Patient Safety Committee meets to approve moving forward (CEO, COO, Legal, HR, clinical leadership, Infection Control, Occupational Health+) - Executive Medical Board affirms decision June 2009: - Board of Directors affirms program
August 2009: - Formal program announcement to CHOP community
Sept-Nov 2009: - Initial mandated program cycle
Early 2010: - Survey of employee perceptions/key messages focus developed
Sept-Nov 2010: - Second seasonal flu vaccination cycle completed - Key messages identified in survey used in education and communication materials.

7. Case Study Snapshot Children’s Hospital of Philadelphia (CHOP)
Key Strategies/Success Factors - Define target population early, announce clearly
Assure robust tracking system, ability to generate interim reports for local
manager action/follow-up
Have plan for interrupted vaccine supply
Develop detailed exemption review process
Develop policies around verifying outside vaccination/documentation levels

8. Case Study Snapshot Children’s Hospital of Philadelphia (CHOP)
Best sound bite(s) 2010 Campaign Leadership Communication from Steve Altschuler, CHOP President & CEO .   “Patients and families come through our doors hoping for great outcomes and expecting to be safe.  Employees come through our doors hoping to deliver great outcomes and expecting to be safe.  It is the role of the leader to ensure both.  The 2010 influenza season is upon us, and like last year, we are making vaccination a condition of service for all health care workers and strongly encouraging all other employees to get the vaccine. .    “2009 was the first year that vaccine was classified as mandatory for health care workers.  Employees were overwhelmingly supportive of the decision to protect patients and staff by getting vaccination…. .   “…Given the importance of creating the safest environment for patients and staff, I expect that employees will not come to work with flu symptoms that may include fever, cough, body aches, sore throat, and/or diarrhea, despite having received vaccination.  Every employee should be free of fever for at least 24 hours before returning to work. .   “Our role as leaders is maintain the safest environment possible.  Please encourage ALL employees to get vaccinated – because EVERYONE has a role in contributing to a safe environment.”

9. Case Study Snapshot Children’s Hospital of Philadelphia (CHOP)
Vaccine Volume 29, Issue 9 pp (17 February 2011) Regular Papers
Employee designation and health care worker support of an influenza vaccine mandate at a large pediatric tertiary care hospital
Original Research Article  [pdf here:  Vaccine_Feemster et al_HCW Flu Vaccinations_Feb 2011 ] Pages Kristen A. Feemster, Priya Prasad, Michael J. Smith, Chris Feudtner, Arthur Caplan, Paul Offit, Susan E. Coffin

10. Case Study Snapshot Children’s Hospital of Philadelphia (CHOP)
Vaccine - Volume 29, Issue 9 pp (17 February Regular Papers
Employee designation and health care worker support of an influenza vaccine mandate at a large pediatric tertiary care hospital
Abstract Aim - Determine predictors of support of a mandatory seasonal influenza vaccine program among health care workers (HCWs). Scope - Cross-sectional anonymous survey of 2443 (out of 8093) randomly selected clinical and non-clinical HCWs at a large pediatric network after implementation of a mandatory vaccination program in 2009–10. Results HCWs (58.2%) completed the survey and 75.2% of respondents reported agreeing with the new mandatory policy. Most respondents (72%) believed that the policy was coercive but >90% agreed that the policy was important for protecting patients and staff and was part of professional ethical responsibility. When we adjusted for attitudes and beliefs regarding influenza and the mandate, there was no significant difference between clinical and nonclinical staff in their support of the mandate (OR 1.08, 95% C.I. 0.94, 1.26). Conclusions - Attitudes and beliefs regarding influenza and the mandate may transcend professional role. Targeted outreach activities can capitalize on beliefs regarding patient protection and ethical responsibility.

12. Key Resources on Website: CHOP Flu Vaccination Campaign Documentation
CHOP CEO Leadership Communication_2010 Campaign_September 2010: CHOP_Leadership Communication from CEO_2010 Season
CHOP Senior VP, Human Resources: 2010 Mandatory Flu Vaccination Latter, September 2010: CHOP_Rob Crober Flu Vaccine Program Letter 2010
2010 Campaign Fact Sheet: CHOP_Flu Vaccine Fact Sheet_16 Sep 2010
Carrots and Sticks:Influenza Vaccination of Healthcare Workers Powerpoint pdf: Coffin_Flu Vax of HCW-CHOP_June Susan Coffin, Children’s Hospital of Philadelphia, June, 2010

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