January 12, 2021

$500 bonuses? Free waffles? How health systems are rewarding staff for getting vaccinated.

Daily Briefing

    To encourage frontline staff to get vaccinated against the novel coronavirus, health systems are offering employees everything from gift cards, $500 bonuses, free breakfasts at Waffle House, raffle tickets, and even socially distant parties.

    Radio Advisory episode: Your role in vaccine distribution (and why it's harder than you think)

    Background

    FDA has granted emergency use authorizations for two Covid-19 vaccines in the United States basedon existing evidence that shows they are safe and effective. Medical journals have published "extensive data" on the vaccines, FDA has publicly shared its data analyses, and "there have been no signs of widespread severe side effects" resulting from vaccination, the Associated Press reports.

    And overall, although the federal government hasn't released any official data on how many of those who are eligible for vaccination have opted to do so, many medical facilities across the country have reported near-universal vaccine uptake among frontline staff, particularly at hospitals, AP reports.  

    However, anecdotal data from certain health care facilities—particularly nursing homes and long-term care facilities—suggests that at least some health care workers are hesitant about getting the vaccine. In fact, according to a CDC survey released before the vaccines received emergency use authorization, only about 60% of health care workers said they were willing to receive the vaccine.

    "I don't think anyone wants to be a guinea pig," Stephen Noble, a 42-year-old cardiothoracic surgeon in Oregon, explained. Noble, who plans to wait until April or May to get the vaccine, added, "At the end of the day, as a man of science, I just want to see what the data show. And give me the full data."

    According to AP, some locations are reporting that nearly 80% of staff are opting to hold off. For instance, at PruittHealth, which operates about 100 long-term care facilities in the South, fewer than 3 in 10 staff members eligible for the vaccine have opted to receive it. "It's far too low," PruittHealth CEO Neil Pruitt said. "It's alarmingly low."

    Experts hypothesize that much of this hesitation stems from the widespread misinformation about vaccines, AP reports, as well as mixed messages from political leaders. "It's a race against social media," Martin Wright, head of the West Virginia Health Care Association, said.

    Facilities unveil incentive programs, communication strategies

    To reassure staff concerns about safety—and to boost overall vaccine uptake—health systems, medical facilities, and even state officials have unveiled a range of communication strategies and incentives, Modern Healthcare reports.

    For instance, Lloyd Dean, CEO of CommonSpirit Health, received the vaccine on Dec. 29, 2020, after several weeks of it being available to only frontline staff. A spokesperson explained the decision, writing, "We think it's important for our hospital and system leaders to show that they're willing to receive the vaccine alongside their staff."

    And at Ochsner Health, the chief academic, medical, and nursing leaders not only received the vaccine, but shared photographs of the process among staff to encourage staff. And Robert Hart, CMO at Ochsner, said interest in getting the vaccine has only increased as the rollout continues. "There was a group of our employees who were kind of taking this 'let me wait and see how that first run goes' (approach)," Hart said, "and now that people are getting their second shot, there is kind of this collective sigh of, 'Well OK, we can go ahead and do it.'"

    Our Lady of the Lake Regional Medical Center in Louisiana reported a similar turnaround, AP reports. "The biggest thing that helped us to gain confidence in our staff was watching other staff members get vaccinated, be OK, walk out of the room, you know, not grow a third ear, and so that really is like an avalanche," said CMO Catherine O'Neal. "The first few hundred that we had created another 300 that wanted the vaccine."

    Other health systems are taking a different approach, Modern Healthcare reports. For instance, Mount Sinai Health System is not offering the vaccine to C-suite leaders unless they treat patients. "If a member of the C-suite never goes to a clinical area, they are not prioritized," Waleed Javaid, director of infection prevention and control at Mount Sinai, said.

    Similarly, a Providence spokesperson said the system's CEO, Rod Hochman, plans to get the vaccine after more frontline workers have—but will be sure to inform staff as soon as he does. And at Baptist Health Louisville, leaders are unveiling a communication strategy to encourage nonmedical staff in particular, who appear to be more hesitant than medical staff, to get vaccinated. 

    Meanwhile, Trinity Health has hosted a series of town halls on the vaccines' safety and efficacy, which have been well attended, AP reports. In fact, since the vaccine became available, 40% of the system's employees have received the vaccine, and recent polling suggests 70% are willing to do so.

    Trinity's C-suite leaders also publicized their plans to get the vaccine as early as this week, when they will be eligible, according to Modern Healthcare. "We wanted to focus first on our front-line caregivers," Daniel Roth, Trinity's CCO, said. But "[f]or our leadership team and for people like me, we have said, 'We'll get the vaccine when it's our turn and we are eager for that.'"

    And still other health systems are adopting more direct incentive programs. For instance, Houston Methodist CEO Marc Boom said his system opted to offer $500 bonus to workers who get vaccinated after system realized that employees may be hesitant.

    He explained that while about half his staff, especially those on Covid-19 units, quickly got vaccinated, 10% to 15% remain very cautious and the remaining 40% are waiting to see how the first wave goes. "We are hoping this bonus program is a little bit of a nudge to move a little faster than they would have otherwise," Boom said.

    Similarly, SavaSeniorCare is offering cash to 169 of its long-term care facilities to cover the cost of incentives, such as gift cards or socially distanced parties, to encourage vaccine uptake. And PruittHealth has partnered with Waffle House to buy breakfast for employees who are vaccinated, in addition to entering vaccinated employees into a "continuing raffle" for prizes, the Wall Street Journal.

    And according to AP, states are also taking action. For instance, the governor of South Carolina is giving health care workers until Jan. 15 to get vaccinated, or risk being moved "to the back of the line."

    And in Georgia, state officials have permitted some vaccines to be given to other essential workers, such as firefighters and police, given the slow uptake among medical professionals. "There's vaccine available but it's literally sitting in freezers," said Public Health Commissioner Kathleen Toomey. "That's unacceptable. We have lives to save" (Condon et al., Associated Press, 1/8; Castellucci, Modern Healthcare, 1/9; Mathews/Toy, Wall Street Journal, 12/20/20). 
     

    Advisory Board's take

    5 common Covid-19 vaccine concerns and how to address them 

    By Monica Westhead, Practice Manager

    Even before the Covid-19 vaccines received their EUAs, polling data suggested vaccine hesitancy was going to be an obstacle for public health officials to address to achieve the needed 60-80% vaccination threshold experts say the nation must meet to achieve herd immunity. And while some of the health care worker vaccine refusal figures are certainly shocking—especially in long-term care settings—right now this is anecdotal evidence: we do not have official numbers on how many health care workers have and have not been vaccinated. It's also worth noting that many hospitals across the country are reporting near-universal vaccine uptake among frontline workers.

    But despite this early uptake, some staff have not opted into vaccination at this time. Whether their hesitation stems from historical medical mistrust or rampant misinformation on social media, leaders need to take an active role in dispelling rumors and encouraging vaccines in the weeks and months to come.

    Medical journals have published fairly extensive data on the available vaccines and FDA has publicly shared its data analyses used for the EUAs. But when you have vaccine conversations with staff, you'll want to move beyond this information. Rather, leaders need to really listen and understand staff concerns related to the vaccine. Below, I offer five common concerns and misconceptions related to the Covid-19 vaccine and ways to address them with staff:

    1. "Potential side effects, particularly side effects so significant that I could be out of work, and that may put additional burden on my already-strapped coworkers": When talking to your clinicians about potential side effects it's important to acknowledge the risk that comes with taking any drug, but you also need to fully understand what is driving their concern. For some, they may have personal reasons to be wary of a new vaccine, such as a bad experience with a previous flu shot, others may be concerned about short-term side effects temporarily impacting their work and placing a larger burden on their coworkers.

    When addressing this concern leaders should reframe the conversation: the latest clinical trial data shows side effects for both the Moderna and Pfizer vaccines were generally mild-to-moderate, and both companies are monitoring instances of any additional and more serious side effects. For instance, one thing to keep an eye on is that eight trial participants who received the vaccine developed appendicitis during the follow-up period, compared to four who received a placebo. Further, regulators in Britain have advised people with a history of allergic reactions not to get the vaccine, based on two reports of anaphylaxis in early vaccine recipients. In the United States, we've seen at least 20 documented cases of allergic reactions to the vaccine. As such, guidance now recommends vaccine recipients be monitored for 15 minutes—and doctors know how to respond if a reaction occurs. 

    2. "I'm skeptical of the mRNA vaccines because they are new and largely untested": This may be the toughest one to address because the mRNA vaccines are a relatively new platform and it can be tough to overcome providers who seek more long-term data. As the article above mentions, many hospitals have seen success through example. As such, leaders should consider identifying a "vaccine champion," someone who is well-respected among the staff to get the vaccine and share their experience. Some health care leaders also have tried to incentivize staff to vaccinate early through monetary and food incentives.

    3. "History and personal experience have taught me to be cautious of medical institutions." The United States has a history of racist, and at times dangerous, health policies and clinical experiments have targeted particularly vulnerable Black and brown communities. This resulted in a legacy of mistrust in medical institutions, research institutions, and the federal government that lowers people of color's confidence in the safety of the vaccine. While addressing the mistrust of medical institutions should be a priority for leaders, there are additional barriers (e.g., cultural nuances and cost) to accessing care for marginalized groups that will prevent those willing to take the vaccine from receiving it. Leaders must take these concerns into account as they will influence their providers' willingness to take the vaccine. Your best bet is to unpack the nuance behind the vaccine hesitancy, amplify the voices of people of color to ease fears, and disseminate a clear message regarding how marginalized communities can access the vaccine.

    4. "I don't need the vaccine because I was infected with Covid-19": The key to addressing this concern is unpacking the why. Some staff may decline the vaccine to allow someone who has no potential immunity to receive it first while others may be citing misinformation. Regardless, it's important to stress that researchers still do not how long natural immunity may last, and therefore, CDC recommends getting the Covid-19 vaccine even if you have already had and recovered from Covid-19.

    5. "The vaccine will give me, or my family, Covid-19": Fear of bringing Covid-19 home to loved ones is a very real fear among health care workers. It's one that leaders have been addressing throughout the year by listening to those concerns and doing everything possible (from adequate PPE to finding a safe place for providers to rest) to protect staff. But this is a case where we have medical understanding and you can clearly state the facts. CDC notes that none of the Covid-19 vaccines available in the United States are made with the live virus that causes Covid-19, meaning the vaccine cannot give you Covid-19.

    In addition to the above, health care leaders should have a dedicated set of contacts for staff to reach out to if they have additional questions, either about the vaccine or about their own personal circumstances. The important take away though is be an active listener and truly understand why your team may be hesitant to get the vaccine. It's likely that health care workers will set the tone for vaccination rates in the country as we enter the next phase of mass vaccination. That's because one of the most effective ways to address vaccine hesitancy is to see a known or trusted individual safely get the vaccine—and health care providers annually rank among the most trusted professions.

    So talk with your staff, provide them the facts as you have them, and work to dispel social media myths or legitimate fears. For tips on how to talk to staff about sensitive Covid-related issues, check out the below articles:

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