title: Carrots and sticks: achieving high healthcare personnel influenza vaccination rates without a mandate.
abstract: OBJECTIVE
  Achieving high healthcare personnel (HCP) influenza vaccination rates has typically required mandating vaccination, which is often challenging to implement. Our objective was to achieve >90% employee influenza vaccination without a mandate.
  
  
  METHODS
  Prospective quality improvement initiative
  
  
  METHODS
  All employees of a 2-hospital, 1,100-bed, community-based academic healthcare system.
  
  
  METHODS
  The multimodal HCP vaccination campaign consisted of a mandatory declination policy, mask-wearing for non-vaccinated HCP, highly visible "I'm vaccinated" hanging badges, improved vaccination tracking, weekly compliance reports to managers and vice presidents, disciplinary measures for noncompliant HCP, vaccination stations at facility entrances, and inclusion of a target employee vaccination rate (>75%) metric in the annual employee bonus program. The campaign was implemented in the 2011-2012 influenza season and continued throughout the 2012-2013 through 2014-2015 influenza seasons. Employee compliance, vaccination, exemption and declination rates were calculated and compared with those of the seasons prior to the intervention.
  
  
  RESULTS
  Compared with vaccination rates of 57%-72% in the 3 years preceding the intervention, employee influenza vaccination increased to 92% in year 1 and 93% in years 2-4 (P<.001). The proportion of employees declaring medical/religious exemptions or declining vaccination decreased during the 4 years of the program (respectively, 1.2% to 0.5%, P<.001; 4.4% to 3.8%, P=.001).
  
  
  CONCLUSIONS
  An integrated multimodal approach incorporating peer pressure, accountability, and financial incentives was associated with increased employee vaccination rate from ≤72% to ≥92%, which has been sustained for 4 influenza seasons. Such programs may provide a model for behavioral change within healthcare organizations.
authors.affiliation: 1Department of Medicine,Christiana Care Health System,Wilmington,Delaware.
authors.forename: Marci
authors.initials: M
authors.lastname: Drees
authors.affiliation: 2Department of Infection Prevention,Christiana Care Health System,Wilmington,Delaware.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Wroten
authors.affiliation: 3Department of Employee Health Services,Christiana Care Health System,Wilmington,Delaware.
authors.forename: Mary
authors.initials: M
authors.lastname: Smedley
authors.affiliation: 3Department of Employee Health Services,Christiana Care Health System,Wilmington,Delaware.
authors.forename: Tabe
authors.initials: T
authors.lastname: Mase
authors.affiliation: 6Perelman School of Medicine,Wharton School of Business and Leonard Davis Institute of Health Economics,University of Pennsylvania,Philadelphia,Pennsylvania.
authors.forename: J Sanford
authors.initials: JS
authors.lastname: Schwartz
mesh_terms: D000046:Academic Medical Centers / Q000379:methods / Q000706:statistics & numerical data; D001291:Attitude of Health Personnel; D003695:Delivery of Health Care; D019983:Guideline Adherence / Q000592:standards / Q000706:statistics & numerical data; D006282:Health Personnel / Q000706:statistics & numerical data*; D006801:Humans; D017589:Immunization Programs / Q000379:methods / Q000706:statistics & numerical data; D007251:Influenza, Human / Q000453:epidemiology / Q000517:prevention & control*; D017146:Models, Organizational; D016134:Organizational Policy; D058996:Quality Improvement / Q000458:organization & administration*; D014481:United States / Q000453:epidemiology; D014611:Vaccination / Q000379:methods / Q000592:standards