A Statewide Healthcare Worker Influenza Vaccination Policy: Strategies to Overcome Implementation Barriers

Introduction

In October 2012, the Rhode Island Department of Health (RI HEALTH) enacted a statewide policy requiring healthcare workers (HCWs) to receive or formally decline an influenza vaccination. The policy included a mandate that unvaccinated workers had to wear a mask during patient contact if influenza was declared widespread.

Methods

RI HEALTH contracted JSI Research & Training Institute, Inc. to conduct semi-structured key informant interviews in order to evaluate the policy implementation. Key informants from healthcare facilities and health policy stakeholder organizations were asked to provide feedback on their experiences with the policy. Interviews focused on the policy’s impact, compliance issues, and barriers to implementation and strategies to overcome them.

Results

Barriers to policy implementation included HCWs’ resistant attitudes towards vaccinations, challenges in tracking compliance, and strains on facility resources. Strategies to address these barriers at the facility-level included unique staff education campaigns and dynamic monitoring systems to track staff compliance to the policy. Macro-level recommendations included the development of a formalized, statewide definition of a “HCW” and the continuation of RI HEALTH’s strong efforts to engage community stakeholder buy-in for the policy.

Discussion and Conclusion

RI HEALTH experienced an increase in HCW influenza vaccination rates, despite encountering barriers to policy implementation. Healthcare facilities and health policy stakeholder organizations adopted new and adapted pre-existing mechanisms to meet compliance requirements and enhance educational efforts. Findings also suggest that Rhode Island’s experience could be used as model for other states planning or considering implementation of a similar policy.