Mandatory influenza vaccination program proves successful in its first year.

Vidant Health is a health care system comprising many physician practices, 9 hospitals, and an academic medical center affiliated with the Brody School of Medicine at East Carolina University. The system is headquartered in Greenville, North Carolina, and its network spreads throughout the 29 counties of Eastern North Carolina. Vidant Medical Center, a teaching hospital with 909 beds, serves as a health care resource throughout the region and delivers comprehensive tertiary care, education, and research. In 2012 Vidant Health joined a growing number of hospitals and health systems around the country in implementing a mandatory influenza vaccination program for its employees and physicians. Every influenza season increases patients’ risk of infection and possible complications, especially for vulnerable patients in a tertiary care setting. Exposure to influenza among Vidant Health’s employees also threatens the operation of its clinics and hospitals and has the potential to reduce access to care. The leaders and employees of Vidant Health believe that the needs of the patient come first, and staff members accept their responsibility to model healthy behaviors. Thus, David Herman, chief executive officer of Vidant Health, proposed a mandatory vaccination program in the interest of patient safety, saying, “Patients trust that when they come to us for care, their health will improve and they will not be put at risk because we did not do everything possible to prevent harm” (written communication to employees, October 2012). In previous years, Vidant Health had less than 75% compliance with influenza vaccination among its health care workers, despite efforts to promote vaccination. One reason for reduced participation was fear on the part of some staff members that vaccination would result in a more serious illness, such as Guillain-Barre syndrome. In addition, Vidant Health faced 2 other obstacles to making vaccination mandatory: the difficulty of confirming that an employee had received the vaccine, and concern that requiring vaccination would negatively affect the satisfaction of employees or affiliated physicians. The decision to move forward with mandatory vaccination came after months of deliberation. Once the clinical governance committee of the health system achieved consensus, the decision became policy. Vidant Health followed the leadership of executive staff members and the physicians’ medical executive committee to ensure that evidence of vaccination was provided by all medical, clinical, and administrative staff members; volunteers; students; and vendors. Individuals with certain medical conditions or religious beliefs, as defined in the policy, were exempt from the mandatory vaccination. Compliance became a condition of employment for all staff as well as a condition of medical privileges for physicians. Vaccination was centrally coordinated and provided free of charge. Vaccination clinics were offered over a 3-month period to accommodate varying work shifts and to make vaccination available to employees and physicians who were working off site. A comprehensive communication strategy was used to educate individuals about the risk that influenza poses to patients, especially high-risk or immunocompromised patients, and the impact of illness on the workforce and the community. Physicians and staff members were receptive to the mandatory vaccination initiative and quickly became ambassadors for its implementation. Influenza vaccination compliance ultimately reached 99.9%, demonstrating the commitment of Vidant Health’s physicians and employees to patient safety. Despite concerns about a negative reaction or employee turnover among Vidant Health’s teams, compliance with the policy was nearly universal. All physicians complied with the policy, as did all but 1 of more than 12,000 employees. Also, only 1 acute hospitalized influenza case was detected in the health system during the first year of mandatory vaccination (although we cannot prove any association with the vaccination program). The leaders of Vidant Health are certain that the decision to require influenza vaccination served the purpose of protecting patients. The initiative has also had a positive impact on the culture of patient safety, resulting in a more engaged health care team that is working to put patients’ needs first.