A Qualitative Analysis of the Impact of Healthcare Personnel Influenza Vaccination Requirements in California

Published in: Vaccine, v. 32, no. 25, May 2014, p. 3082-3087

Posted on RAND.org on January 01, 2013

by Dmitry Khodyakov, Lori Uscher-Pines, Suchita A. Lorick, Megan Lindley, Victoria Shier, Katherine M. Harris

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Research Question

  1. Did California's law requiring influenza vaccinations for hospital-based health care personnel increase vaccination rates?

OBJECTIVE: Using qualitative methods, we explored the implementation of California's 2007 influenza immunization requirements of hospital-based health care personnel (HCP). METHODS: We conducted nine case studies of California hospitals with different HCP vaccination rates and policies. Case studies consisted of interviewing 13 hospital representatives and analyzing relevant hospital documents, including influenza policies. We also conducted 13 semi-structured phone interviews with key state and county public health officials, union representatives, and officials of various professional healthcare organizations. RESULTS: Our qualitative results suggest that California's vaccination requirements likely did not increase influenza vaccination uptake among HCP. The law was not strong enough to compel hospitals with low and medium vaccination rates to improve their vaccination efforts, and hospitals with high vaccination rates were able to comply fully with the law by continuing to do what they were already doing - namely offering vaccinations to HCP, providing education about the risks of influenza and the benefits of vaccination, and obtaining signed declinations from those who refuse vaccination. Nonetheless, we found that by publicly raising the issue of influenza vaccination in the context of public safety and healthcare quality, California's law encouraged hospitals to develop and implement data systems to monitor the effectiveness of vaccination promotion efforts and prompted discussions, and, in some cases, adoption of stricter vaccination requirements at hospital or county levels. CONCLUSIONS: Our findings generally support the literature that suggests that permissive influenza vaccination requirements, though politically feasible, provide little direct incentive for hospitals to focus efforts on increasing HCP vaccination rates.

Key Findings

California's vaccination requirement probably did not increase influenza vaccinations among health care personnel.

  • The law was too weak to encourage hospitals with low vaccination rates to improve.

Hospitals with high vaccination rates complied with the law by continuing to do what they were already doing with little incentive to improve.

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