March 31, 2021

Nearly 50% of staff at a nursing home opted against Covid-19 vaccines. Then the CEO launched a bold campaign.

Daily Briefing

    When nearly half of the staff at a Washington, D.C., nursing home opted not to get the Covid-19 vaccine when it became available. But then, the facility's CEO, Tina Sandri, launched a two-month campaign to change their minds—and ultimately got 79% of her staff vaccinated. Here's how she did it, according to the New York Times' Abby Goodnough.

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    Background

    Staff and residents at nursing homes and assisted care facilities were among the first wave of people eligible to receive the Covid-19 vaccines. Under a federal program that dispatched vaccinators from CVS and Walgreens to facilities around the country, "nearly all of the vulnerable residents of the facilities" received the vaccine, according to the Goodnough.

    However, "reaching the mostly low-wage employees of the facilities…proved far more difficult," the Times reports. Sandri's nursing home, called Forest Hills of D.C., was no different.

    While nearly all the facilities' residents received the vaccination during the facility's first vaccination day on Jan. 4, an estimated 92 staff members—including nurses, kitchen and activities staff, security personnel, and more—declined. Many of those who declined were Black, the Times reports, as reflected the "overall makeup of the home's work force; many were immigrants from African countries, such as Nigeria, Liberia, and Cameroon."

    However, despite the staff's hesitancy, Sandri wasn't deterred, the Times reports. The vaccinators would return twice more, in February and in March, and Sandri was determined to change the minds of those who had refused.

    A plan to persuade—not 'bribe'

    In the weeks leading up to the first vaccination day, Sandri tried to use science to convince the staff to get vaccinated, leading a series of explanatory huddles about the vaccine with each department. However, she stopped short of using incentives popular at other nursing homes, such as gifts cards, bonuses, or extra vacation days, saying such offers were akin to "bribes."

    "We're doing this because we care," she said. "To dilute that message with other things is almost patronizing to people's intellect."

    When the first vaccination day arrived, Sandri made a point to make it to feel festive, with music and snacks. However, when nearly half of her staff still refused to get vaccinated, she knew she needed a new approach to reach them.

    This time, to gear up before the vaccinators returned in early February, Sandri started texting staff with messages about the science behind the vaccine. She recruited one of the young, popular staff members, Miles Lee, to help persuade his colleagues as an "influencer." And she set up a "Heroes of Hope" wall featuring photos of staff who had been vaccinated. She also started playing Tyler Perry's 30-minute television special on the vaccines on a giant screen—in a loop.

    But most importantly, Sandri said, she tried to listen and respond to their individual concerns. "You really have to listen to each person's story and address it from that standpoint, so they feel, 'This is a workplace that cares about me,'" she said.

    When the vaccinators returned, another 48 staff members opted to get the shot. Sandri felt as if she was making progress, but she felt she needed to do more over the next month—before the vaccinators returned for their final visit—to convince those staff who remained unpersuaded.

    The final push

    Around this time, the Times reports, Sandri realized the half-hour Tyler Perry video wasn't having the intended effect. That was pivotal, she said, to realizing she had been approaching the issue incorrectly.

    Sandri, who is of Chinese descent, explained, "I'm Asian, but I'm not Japanese or Thai or Indian, and they are very different people. Until we understand cultural sensitivities beyond the major skin color groups, we're not going to be successful at reaching herd immunity levels with some of those subsets."

    To accommodate these sensitivities, Sandri reached out to her director of maintenance, an immigrant from Africa who received his vaccination, to talk with his vaccine-hesitant peers about their concerns and his own experience. She also looked for "leaders of local African churches who might be willing to do the same," the Times reports.

    And all the while, she "doubled down on what she believed was working best: listening to and addressing the concerns of her employees one by one—what she called a 'time-intensive, conversation-intensive, case-by-case uphill climb.'"

    According to Sandri, the key she'd learned in that approach was to tailor her message to each person. "For analytical people, we provided data on number of cases, number of people in trials, percent of people who experience an immune response," she said. "For relationship-based thinkers, we asked if they had any vulnerable friends or family members, and how having or not having the vaccine might impact the relationship."

    For instance, Sandri took care to speak repeatedly with one security officer, Mariah Proctor, who during the first event had declined the vaccine based on her mother's concern about how little was known about the vaccine or its ingredients.

    And while Proctor began thinking about getting the vaccine by the time the second event rolled around—thanks in part to colleagues who had received the shot themselves—she still didn't feel comfortable getting it herself. She had lingering concerns about having a "bad reaction," and she'd heard frightening stories about vaccine trial enrollees dying, stories she didn't believe but which she said stayed "in the back of [her] head."

    But in early March, when the third event came around—with Sandri frequently stopping by her desk to chat about the benefits of being vaccinated—Proctor felt she was ready to get the vaccine. Proctor thought she'd get the vaccine primarily to help protect her sister, with whom she lived, and to protect herself when she could resume her second job as a bartender.

    "It gave me a little more confidence," she said. "I don't know anyone in my immediate circle that took the vaccine yet, and it just makes me feel like if no one else has done it, then maybe I should."

    Overall, 79% of the staff ultimately got vaccinated, the Times reports—a total surpassing the goal set by the American Health Care Association to vaccinate at least 75% of the country's nursing home workforce by the end of June. "I'm ready to do cartwheels down the hallway," Sandri said.

    Recounting what she had learned from her efforts, Sandri added, "Everyone's fears are real, whether or not they are grounded in science or in something they believe right now. Beliefs change with time or new knowledge, so we have to ride it out. Listen hard, don't judge and let them move at their own pace" (Goodnough, New York Times, 3/29).

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