Case Study Modules

1. Pennsylvania Health Care Worker Flu Immunization CampaignA Patient Safety & Employee Health InitiativeTraining Resources:Cast Study Module: Main Line HealthVersion 1.1June 2011

2. Case Study Modules • Based on interviews with leaders at institutions representing best and promising practices • Focus on common elements of strategy, decision to implement programs, internal support and barriers • Focus on mandatory programs given policy and ethics foundations • Recognition that each institution is unique, but overall goal (90%+ uptake) is patient safety/ employee safety imperative is same everywhere!

3. Case Study SnapshotMain Line Health • Main Line Health is suburban Philadelphia's most comprehensive healthcare resource, offering a full range of medical, surgical, obstetric, pediatric, psychiatric and emergency services. Forming the core of Main Line Health are four of the region's most respected acute care hospitals—Lankenau, Bryn Mawr, Paoli and Riddle—as well as one of the nation's premier facilities for rehabilitative medicine, Bryn Mawr Rehab Hospital. We're especially recognized for our cardiac, orthopedic, oncology, rehabilitation and women's clinical services. [10,000 employees, 2,750 physicians]http://www.mainlinehealth.org/oth/Page.asp?PageID=OTH000030 • Contacts:- Constance Cutler, RN, MS, CIC, FSHEA; Director, Infection Prevention and • Control, Main Line Health, CutlerC@MLHS.ORG; (484) 476-3906 • Patty McBride, RN, MSN, CIC; Infection Preventionist, Bryn Mawr • Hospital,  McBrideP@MLHS.ORG; (484) 337-3470

4. Case Study SnapshotMain Line Health OverviewAfter averaging seasonal vaccine uptake among its HCWs of about 60% for several years despite active annual campaigns, Main Line Health adopted a mandated program for the 2010-11 flu season, achieving a 99.99% uptake. Seasonal Influenza Vaccine Uptake Pre-mandate             Post-mandate ≈ 60%                    99.99%

5. Case Study SnapshotMain Line Health Program JustificationPositioned as a patient safety initiative which involves entire Main Line Health community including physicians. Program Details- establishes seasonal flu vaccination as a condition of employment - impacts all employees, employed physicians, volunteers, students, vendors with patient contact (consent form) - impacts non-employee professional staff credentialed by medical staff (privilege suspension) - integrates medical exemptions (physician letter; no allergy testing) and religious exemptions (letter from clergy reviewed by outside independent party (retired judge)): very low incidence rate

6. Case Study SnapshotMain Line Health Key Champion(s)-Main Line Health CEO John Lynch - drove the initial decision based, in part, on his experience in Houston with a hospital flood event: act where you can to avoid disaster- Infection Preventionists/Occupational health- HR Directors (data sharing with managers on unit uptake) Best sound bite(s)During formal campaign and rounding visits to key units, the VP of Nursing from one hospital encountered “senior” maternity nurses: Question: “Are you really going to fire all of us if we don’t get vaccinated?” Answer: “Yes ladies, we are.” Result: They accepted influenza vaccinations towards the deadline.

7. Case Study SnapshotMain Line Health TimelineApril-August 2009:- Initial consideration of a mandate program…HR Directors meeting…H1N1 pandemic and vaccine supply pushes decision off to next cycle Jan-Feb 2010:- Groundwork laid with legal, HR- Steering Group formed/mandate decision affirmed: CMO, HR, Legal, Patient Safety, Occupational Health, Nursing, Infectious Disease++) May-June 2010:- Review and approvals by Medical Executive Committee and Board of Directors- Launch letter to employees from CEO/CMO Late Dec 2010/early Jan 2011- Formal campaign window

8. Case Study SnapshotMain Line Health • Key Strategies/Success Factors- Use of own employees (community health nurses) to “deliver” • immunizations in the mandate context • Use of employee intranet to post key program content ands help assure • continuity of messaging across stakeholder groups • Posted base set of 10 Frequently Asked Questions (FAQs) which built to • twenty; employees could post new questions and get direct response • Emphasis on physician inclusion in requirement: increased safety • perception, etc. • Moving from paper-based form to badge reader to track

9. Case Study SnapshotMain Line Health • Leadership Team (functions that made it happen)The Steering Group pared down to a handful of key players who held weekly status phone calls, then almost daily calls during the last week.  Key players included: • Infection Prevention • Infectious Diseases • Occupational Health • Chief Medical Officer • Human Resources Director • others as necessary…

10. Case Study SnapshotMain Line Health

11. Case Study SnapshotMain Line Health • Key Resources on website • MLH CEO/CMO Campaign Letter 2010: MainLineHealth_CEO-CMO Campaign Letter • MLH Employee Flu Vaccination Admin Policy: MLH_Flu Vaccination Policy 2010 • MLH Intranet Frequently Asked Questions: MLH_Flu vaccine – Frequently Asked Questions 2010 • MLH Medical Exemption Form 2010: MLH_Flu Vax Medical Exemption Form – 2010 • MLH Campaign Poster (above): MLH_FluFlyer-8 5×11

12. Group Exercise • What strategies from the Main Line case study might work well in your institution? Why? • What parts of the Main Line experience would NOT work for your institution? Why? • What barriers do you see within your institution moving towards a mandatory program? • Which barriers are not addressed in the Main Line experience? We will use observations and answers to build a collection of “frequently-asked-questions” (FAQs) for the website