title: Organizational factors associated with Health Care Provider (HCP) influenza campaigns in the Veterans health care system: a qualitative study.
abstract: It is an important goal to vaccinate a high proportion of health care providers (HCPs) against influenza, to prevent transmission to patients. Different aspects of how a HCP vaccination campaign is conducted may be linked to different vaccination rates. We sought to characterize organizational factors and practices that were associated with vaccination campaign success among six sites within the Veterans Health Administration, where receipt of flu-vaccination is voluntary.
  
  
  
  We conducted a total of 31 telephone interviews with key informants who were involved with HCP flu vaccination campaigns at three sites with high-vaccination rates and three sites with low-vaccination rates. We compared the organization and management of the six sites' campaigns using constant comparison methods, characterzing themes and analyzing data iteratively.
  
  
  
  Three factors distinguished sites with high flu vaccination rates from those with low vaccination rates. 1) High levels of executive leadership involvement: demonstrating visible support, fostering new ideas, facilitating resources, and empowering flu team members; 2) Positive flu team characteristics: high levels of collaboration, sense of campaign ownership, sense of empowerment to meet challenges, and adequate time and staffing dedicated to the campaign; and 3) Several concrete strong practices emerged: advance planning, easy access to the vaccine, ability to track employee vaccination status, use of innovative methods to educate staff, and use of audit and feedback to promote targeted efforts to reach unvaccinated employees.
  
  
  
  Successful HCP flu campaigns shared several recognizable characteristics, many of which are amenable to adoption or emulation by programs hoping to improve their vaccination rates.
authors.affiliation: Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, 27705, USA. zayd.razouki@dm.duke.edu.
authors.forename: Zayd
authors.initials: Z
authors.lastname: Razouki
authors.affiliation: Department of Veterans Affairs, Office of Public Health, Washington, DC, USA.
authors.forename: Troy
authors.initials: T
authors.lastname: Knighton
authors.affiliation: Department of Veterans Affairs, Office of Public Health, Washington, DC, USA.|Departments of Internal Medicine and Pediatrics, Yale University, School of Medicine, New Haven, CT, USA.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Martinello
authors.affiliation: Department of Veterans Affairs, Office of Public Health, Washington, DC, USA.
authors.forename: Pamela R
authors.initials: PR
authors.lastname: Hirsch
authors.affiliation: Department of Veterans Affairs, Office of Public Health, Washington, DC, USA.
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: McPhaul
authors.affiliation: Center for Health care Organization and Implementation research, Bedford VA Medical Center, Bedford, MA, USA.|Department of Medicine, Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA.
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Rose
authors.affiliation: Center for Health care Organization and Implementation research, Bedford VA Medical Center, Bedford, MA, USA.
authors.forename: Megan
authors.initials: M
authors.lastname: McCullough
mesh_terms: D006282:Health Personnel; D006787:Hospitals, Veterans / Q000458:organization & administration; D006801:Humans; D017589:Immunization Programs; D017757:Infectious Disease Transmission, Professional-to-Patient / Q000517:prevention & control*; D007252:Influenza Vaccines; D007251:Influenza, Human / Q000517:prevention & control* / Q000635:transmission; D007407:Interviews as Topic; D036301:Qualitative Research; D014481:United States; D014493:United States Department of Veterans Affairs
chemical_list: D007252:Influenza Vaccines
keywords: Health care provider; Influenza vaccine; Organizational factors; Positive deviance method; Qualitative study