title: A qualitative analysis of the impact of healthcare personnel influenza vaccination requirements in California.
abstract: OBJECTIVE
  Using qualitative methods, we explored the implementation of California's 2007 influenza immunization requirements of hospital-based health care personnel (HCP).
  
  
  METHODS
  We conducted nine case studies of California hospitals with different HCP vaccination rates and policies. Case studies consisted of interviewing 13 hospital representatives and analyzing relevant hospital documents, including influenza policies. We also conducted 13 semi-structured phone interviews with key state and county public health officials, union representatives, and officials of various professional healthcare organizations.
  
  
  RESULTS
  Our qualitative results suggest that California's vaccination requirements likely did not increase influenza vaccination uptake among HCP. The law was not strong enough to compel hospitals with low and medium vaccination rates to improve their vaccination efforts, and hospitals with high vaccination rates were able to comply fully with the law by continuing to do what they were already doing - namely offering vaccinations to HCP, providing education about the risks of influenza and the benefits of vaccination, and obtaining signed declinations from those who refuse vaccination. Nonetheless, we found that by publicly raising the issue of influenza vaccination in the context of public safety and healthcare quality, California's law encouraged hospitals to develop and implement data systems to monitor the effectiveness of vaccination promotion efforts and prompted discussions, and, in some cases, adoption of stricter vaccination requirements at hospital or county levels.
  
  
  CONCLUSIONS
  Our findings generally support the literature that suggests that permissive influenza vaccination requirements, though politically feasible, provide little direct incentive for hospitals to focus efforts on increasing HCP vaccination rates.
authors.affiliation: RAND Corporation, Santa Monica, CA, USA. Electronic address: Dmitry_Khodyakov@rand.org.
authors.forename: Dmitry
authors.initials: D
authors.lastname: Khodyakov
authors.affiliation: RAND Corporation, Arlington, VA, USA.
authors.forename: Lori
authors.initials: L
authors.lastname: Uscher-Pines
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Suchita A
authors.initials: SA
authors.lastname: Lorick
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Megan C
authors.initials: MC
authors.lastname: Lindley
authors.affiliation: RAND Corporation, Santa Monica, CA, USA.
authors.forename: Victoria
authors.initials: V
authors.lastname: Shier
authors.affiliation: RAND Corporation, Arlington, VA, USA.
authors.forename: Katherine
authors.initials: K
authors.lastname: Harris
mesh_terms: D002140:California; D019983:Guideline Adherence / Q000331:legislation & jurisprudence; D006282:Health Personnel; D006291:Health Policy / Q000331:legislation & jurisprudence*; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D007251:Influenza, Human / Q000517:prevention & control*; D014611:Vaccination / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data
keywords: Health care personnel; Influenza vaccination; Mandatory vaccination; State influenza vaccination requirements of healthcare personnel