CHOP Case Study

NEW: PowerPoint presentation by Susan Coffin, MD at Hershey training session 26 July 2011: Coffin_sCarrots and Sticks_CHOP Presentation_26 July 2011

Case Study and Key Resources

DRAFT  4  June 2011

Case Study Snapshot
Children’s Hospital of Philadelphia (CHOP)

After averaging seasonal vaccine uptake among its targeted clinician group of about 90% with very active campaigns, CHOP decided to both expand its target populations beyond clinicians, and instituted a mandated program for the 2099-2010 flu season for all persons who work in buildings where clinical care is delivered, achieving 100% uptake across its 9,500 person community.

Seasonal Influenza Vaccine Uptake

    Pre-mandate                                          Post-Mandate

≈ 90%*                           100%**

                                              *clinician population target                                **overall population

Program Justification
Positioned as a patient safety imperative.

Program Details
– establishes seasonal flu vaccination as a condition of employment
– impacts all employees, volunteers, students, vendors
– impacts non-employee professional staff (university appointments at Penn)
– grants exemptions based on standardized review process: medical – reviewed by medical committee if physician documentation falls outside traditional exemption categories/physician follow-up; religious – reviewed by outside independent party (retired judge): very low incidence rate

Key Champion(s)
Infection Control and Occupation Health

Early 2009:
– Review of 2008/2009 seasonal flu vaccination campaign performance; discussed potential to proceed to mandated program

April/May 2009:
– Hospital Patient Safety Committee meets to approve moving forward (CEO, COO, Legal, HR, clinical leadership, Infection Control, Occupational Health+)
– Executive Medical Board affirms decision
June 2009:
– Board of Directors affirms program

August 2009:
– Formal program announcement to CHOP community

Sept-Nov 2009:
– Initial mandated program cycle

Early 2010:
– Survey of employee perceptions/key messages focus developed

Sept-Nov 2010:
– Second seasonal flu vaccination cycle completed
– Key messages identified in survey used in education and communication materials.

Key Strategies/Success Factors
– Define target population early, announce clearly
– Assure robust tracking system, ability to generate interim reports for local manager action/follow-up
– Have plan for interrupted vaccine supply
– Develop detailed exemption review process
– Develop policies around verifying outside vaccination/documentation levels

Best sound bite(s)
2010 Campaign Leadership Communication from Steve Altschuler, CHOP President & CEO
  “Patients and families come through our doors hoping for great outcomes and expecting to be safe.  Employees come through our doors hoping to deliver great outcomes and expecting to be safe.  It is the role of the leader to ensure both.  The 2010 influenza season is upon us, and like last year, we are making vaccination a condition of service for all health care workers and strongly encouraging all other employees to get the vaccine.
.    “2009 was the first year that vaccine was classified as mandatory for health care workers.  Employees were overwhelmingly supportive of the decision to protect patients and staff by getting vaccination….
  “…Given the importance of creating the safest environment for patients and staff, I expect that employees will not come to work with flu symptoms that may include fever, cough, body aches, sore throat, and/or diarrhea, despite having received vaccination.  Every employee should be free of fever for at least 24 hours before returning to work.
.   “Our role as leaders is maintain the safest environment possible.  Please encourage ALL employees to get vaccinated – because EVERYONEhas a role in contributing to a safe environment.”

Children’s Hospital of Philadelphia
Since its start in 1855 as the nation’s first hospital devoted exclusively to caring for children, The Children’s Hospital of Philadelphia has been the birthplace for many dramatic firsts in pediatric medicine. The Hospital has fostered medical discoveries and innovations that have improved pediatric healthcare and saved countless children’s lives. Over 150 years of innovation and service to our patients, their families and our community, reflect an ongoing commitment to exceptional patient care.

Susan Coffin, MD, MPH; Hospital Epidemiologist and Medical Director, Infection Prevention & Control (215-590-4492)
Mary Cooney, RN; Nurse Manager, Occupational Health (215-590-1938)


Key Resources

CHOP Flu Vaccination Campaign Documentation

– CHOP CEO Leadership Communication_2010 Campaign_September 2010: CHOP_Leadership Communication from CEO_2010 Season

– CHOP Senior VP, Human Resources: 2010 Mandatory Flu Vaccination Latter, September 2010: CHOP_Rob Crober Flu Vaccine Program Letter 2010

– 2010 Campaign Fact Sheet: CHOP_Flu Vaccine Fact Sheet_16 Sep 2010

– CHOP Communications Campaign summary:


Carrots and Sticks:Influenza Vaccination of Healthcare Workers
Powerpoint pdf: Coffin_Flu Vax of HCW-CHOP_June 2010
Susan Coffin
Children’s Hospital of Philadelphia
June, 2010


Peer-reviewed Journal Literature

Volume 29, Issue 9 pp. 1727-1854 (17 February 2011)
Regular Papers

Employee designation and health care worker support of an influenza vaccine mandate at a large pediatric tertiary care hospital

Original Research Article  [pdf here:  Vaccine_Feemster et al_HCW Flu Vaccinations_Feb 2011 ]
Pages 1762-1769
Kristen A. Feemster, Priya Prasad, Michael J. Smith, Chris Feudtner, Arthur Caplan, Paul Offit, Susan E. Coffin
Determine predictors of support of a mandatory seasonal influenza vaccine program among health care workers (HCWs).
Cross-sectional anonymous survey of 2443 (out of 8093) randomly selected clinical and non-clinical HCWs at a large pediatric network after implementation of a mandatory vaccination program in 2009–10.
388 HCWs (58.2%) completed the survey and 75.2% of respondents reported agreeing with the new mandatory policy. Most respondents (72%) believed that the policy was coercive but >90% agreed that the policy was important for protecting patients and staff and was part of professional ethical responsibility. When we adjusted for attitudes and beliefs regarding influenza and the mandate, there was no significant difference between clinical and nonclinical staff in their support of the mandate (OR 1.08, 95% C.I. 0.94, 1.26).

Attitudes and beliefs regarding influenza and the mandate may transcend professional role. Targeted outreach activities can capitalize on beliefs regarding patient protection and ethical responsibility.


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