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Hospital Workers, Flu Shots & Standardized Work

by Mark Graban on November 26, 2012 · 47 comments

flu shot 150x150 Hospital Workers, Flu Shots & Standardized Work lean

While working in different environments and different industries, I’ve seen many work requirements that were deemed “non-negotiable” by management – and rightly so.  For example, wearing safety glasses in a factory or wearing gloves when handling specimens in a hospital lab. Generally speaking, “standardized work” (the way we do things) should be written by the people who do the work (this idea in Lean traces back to Toyota’s  Taiichi Ohno).

While I’ve never been a fan of top-down “command and control” work rules being forced on people (see my recent post on “voluntary standardization“), there’s a time and a place to make things required – especially when safety and quality are involved. Good leaders make sure people understand WHY a non-negotiable rule is required, rather than just saying “do this or you’re fired.”

But what about when patient safety is involved?

As somebody who is in hospitals a lot, as a consultant or a speaker, I get a flu shot each year. I do this both to protect myself from getting sick and to protect others who might be in a vulnerable position in terms of their own health. I think it’s an extension of the “respect for people” principle of Lean for me to do this, beyond the selfish reason of not wanting to get sick.

It’s interesting to see that many doctors, nurses, or healthcare professionals choose to NOT get a flu shot. I am often able to get one easily (and for free) at a hospital site or I pay a few bucks to get one at the local drugstore.

Virginia Mason Medical Center is a world leader in the application of Lean and Toyota practices in healthcare (see more posts about their work).  Joyce Lammert, MD, the  VM Chief of Medicine recently wrote a blog post titled, “Mandatory Flu Shots: A Defining Moment.”

She writes, in part:

A medical assistant on the [Rapid Process Improvement Workshop] team noted many people with the flu are asymptomatic, which meant Virginia Mason staff members could unknowingly spread the flu to vulnerable patients. During a team discussion she asked, “If the patient really came first, shouldn’t everyone at Virginia Mason get a flu shot?”

The policy is certainly patient focused and provides an option for those who really don’t want the shot:

Within two years of implementing the new policy, VM had reached nearly 100 percent of employees getting flu shots (a few employees requested accommodations and were permitted to wear surgical masks instead).

You may have seen this story in the news over the weekend, from Cincinnati: “TriHealth fires 150 employees for not getting flu shots.”

From that story:

TriHealth offered all of its 10,800 employees free flu shots. Employees had a month to get the flu shot. The deadline was Nov. 16. Employees who did not get the shot were terminated Wednesday, a company spokesperson said.

I tried to find other stories that might have mentioned if the TriHealth employees had the option of wearing a mask, as an alternative.

From the online discussion on the story, there were many people who screamed about the rights of the employees. Well, the U.S. Constitution is designed to protect against the government overstepping its bounds, but private employers like TriHealth have far more leeway in choosing who to hire and fire. Some other organizations, like Cleveland Clinic, take this a step farther, perhaps, by refusing to hire smokers (but that’s in the name of keeping health coverage costs down as an employer as opposed to  protecting  patients).

I’m not a fan of firing people as a first step… I’d prefer to find a “win/win” solution that protects patients while finding a way to not lose my investment in talented employees and staff.

But, there’s a big difference between making an intentional choice that puts patients at risk (not getting a free shot that was conveniently offered) and being part of a systematic error. I wouldn’t fire a nurse for giving the wrong medication to a patient, since that’s almost always a very systemic error and the harm that comes from people covering up errors is a reason to not rush to punitive measures for errors and mistakes. Not taking a flu shot is a choice, not a systemic error, though.

There’s a difference maybe that’s similar to this situation in a software company:

  • I made an honest coding error that led to our site crashing (don’t be punitive)
  • I intentionally uploaded a virus that was likely to crash our site (that’s intentional, so punitive is OK)

What’s your take on this situation? I’m curious to hear your comments and, perhaps, about what your organization is doing (or not doing). Remember, you can post a comment under “anonymous” or with a pseudonym.

From a Lean perspective, what’s the balance between the needs of the customer (the patient) and the employees? Is it right in this situation, or other circumstances, to force people to follow standardized work, as we see here with flu prevention?


blog photo Hospital Workers, Flu Shots & Standardized Work leanAbout LeanBlog.org: Mark Graban is a consultant, author, and speaker in the “lean healthcare” methodology. Mark is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, as well as the new Executive Guide to Healthcare Kaizen. Mark is also the VP of Innovation and Improvement Services for KaiNexus.


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{ 47 comments… read them below or add one }

1 Brian Knoblauch November 26, 2012 at 8:19 am

Forcing one to get a shot is an assault upon one’s body. It’s not a choice like you say, it’s actually a basic human rights violation.

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2 Mark Graban
Twitter:
November 26, 2012 at 8:23 am

It’s a choice in the sense that we all choose our employer and most employers have terms and conditions that we might not like. Nobody is forced to get a shot… they can choose to quit (or choose to be fired).

Does a hospital worker have a right to spread illness to patient? What about the patient’s “human rights” to not be harmed by their hospital care?

I’m sympathetic to the employees, but more sympathetic to the patients.

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3 Brian Knoblauch November 26, 2012 at 8:39 am

To say that one has a choice to leave employment is a falsehood that we all continue to put forth. I’ve been guilty of that myself in the past. However, I’ve come to realize as of late that for the bulk of the population leaving a job simply is not an option. It is not a choice that they work at a given place. If they walk away, they will not survive.

The right to not catch a disease from another is a secondary right. Passive harms are an extension to primary physical harm. If we allow the primary physical harm, then there is no valid point for the secondary passive rights to exist to begin with. Human rights start with the individual and flow into societal rights as an extension. Without the core, there is nothing else.

It’s very easy for us to sit upon our pedestals and force individuals to our will. That’s something I’ve historically been guilty of, but I’ve come to see that as an error. In the name of helping others we’ve been willing to throw away the foundation of humanity itself.

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4 Mark Graban
Twitter:
November 26, 2012 at 8:43 am

There are MANY other hospitals or clinics that will employ somebody who has been fired for not taking a flu shot at TriHealth.

I’m not a clinician, but the “harm” from getting a flu shot seems to be far less than the harm caused by giving the flu to a compromised, elderly patient (for whom it might be a death sentence). I think that’s a matter of throwing away the foundation of humanity – a person’s right to not be harmed by another.

I’m more concerned about actual harm than theoretical rights (and there’s not right to not have your employer force a choice between shot and job in the Constitution)… not being a Constitutional scholar, either.

I assume this whole situation will keep some lawyers busy.

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5 Brian Knoblauch November 26, 2012 at 9:03 am

We seem to have reached an impasse as we appear to have differing base beliefs. :-) I don’t believe that a potential fatal harm to one person authorizes a definite minor harm on another. I believe that must be choice *freely* made and not forced upon one. I’m also unconcerned as to Constitutional specifics as the Constitution merely enumerates a few basic rights, it’s certainly not a definition of all rights.

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6 Mark Graban
Twitter:
November 26, 2012 at 9:11 am

Yes, an impasse. But, there’s no “definite harm” from receiving a flu shot.

There’s a choice for the employees… it might be a bad one (take this shot or lose your job), but it’s a choice.

I’d much rather a hospital find a compromise (like Virginia Mason has) – wearing a mask 100% of the time. I’m not sure why TriHealth would throw away talented people who they probably have a lot invested in. Taking the discussion away from “rights,” it might be bad business on the part of TriHealth to not find a compromise. Who knows, maybe these firings are poorly disguised layoffs that are driven for cost reasons, under the guise of patient protection?
Mark Graban recently posted..Hospital Workers, Flu Shots & Standardized WorkMy Profile

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7 Brian Knoblauch November 26, 2012 at 9:42 am

That’s another point we’re not going to be able to meet on. Sticking somebody with a needle is to me a definite minor harm.

Indeed, finding a way to help avoid the spread of disease without jabbing needles into (otherwise) healthy people would be a superior solution.

My *guess* would be that it’s simply the result of seizing on the first solution thought of, without considering all the options and all the people involved. Layoffs don’t tend to be so sneaky in my experience. :-)

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8 Mark Graban
Twitter:
November 26, 2012 at 9:46 am

Oh come on, the shot barely hurts at all.

I wonder if the nasal spray vaccine was an option. Would you be opposed to that?

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9 Mark Graban
Twitter:
November 26, 2012 at 10:21 am

Here is some info from the U.S. government:

http://www.flu.gov/planning-preparedness/hospital/hcworkers_vaccine.html

How Many Health Care Workers Got Vaccinated Last Season?

- During the 2010-2011 influenza season, coverage for influenza vaccination among health care workers was estimated at 63.5%.
- Coverage was 98.1% among health care workers who had an employer requirement for vaccination.

What Does the Research Say?

Health care workers who get vaccinated help to reduce the following:
- transmission of influenza
- staff illness and absenteeism
- influenza-related illness and death, especially among people at increased risk for severe influenza illness
- Higher vaccination levels among staff have been associated with a lower risk of nosocomial (hospital-acquired) influenza cases.
- Influenza outbreaks in hospitals and long-term care facilities have been attributed to low influenza vaccination coverage among health care workers in those facilities.
- Higher influenza vaccination levels among health care workers can reduce influenza-related illness, and even deaths, in settings like nursing homes.

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10 Mark Graban
Twitter:
November 26, 2012 at 10:26 am

And a position paper from the Association for Professionals in Infection Control and Epidemiology:

PDF LINK

As a profession dedicated to the prevention of infection, we have an ethical responsibility to protect those individuals entrusted to our care. We must do a better job of immunizing HCP every year to ensure patient safety and protect those individuals at high risk of developing complications of influenza.

Recommendation:
Therefore, APIC recommends that acute care hospitals, long term care, and other facilities that employ healthcare personnel* require annual influenza immunization as a condition of employment unless there are compelling medical contraindications.

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11 Eden Takhsh November 26, 2012 at 12:24 pm

I am a physician and as a condition of employment and medical staff privileges I am required to have an annual PPD test. There is already a precedence in being stuck by a small needle as healthcare workers as a condition of employment.

If employees have the right to refuse, then as a patient or family member I should have the right to be informed and refuse care from these individuals.

I am not trying to make this a start of a slippery slope through which we mandate various tests and inoculations but if an action is evidence based, then requiring it is reasonable. As long as the reasoning is well explained to the employees.

In my experience most healthcare workers who refuse flu shots do so not based on facts but unproven tales.

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12 Marty November 26, 2012 at 1:36 pm

Great post Mark, and interesting comments. I have a few comments:

1. How is this argument different/same from the secondary smoke argument? In secondary smoke, we are impinging on the freedom of the smoker to prevent potential health issues to passive people.

2. As a patient I would certainly appreciate knowing what percentage of workers at a hospital have had the flu shot in my choice of hospitals, but an even better metric would be how many patients have contracted flu while at the hospital. As long as the whole team kept that metric at a low level, then we should be happy, but if it rises above a trigger, then more draconion measures should be considered.

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13 Mark Graban
Twitter:
November 26, 2012 at 2:04 pm

Marty – to point 1, it seems about the same thing. I’m personally pretty libertarian and part of that view is that your rights extend to the point where they harm me. People don’t have a right to drink and drive and they don’t have a right (I’d argue) to blow carcinogenic air into my face and lungs. Except, as a non-smoker, I have a choice to not go to bars or restaurants that allow smoking and I can easily detect smoke and move away from it. A hospital patient cannot choose if they have vaccinated nurses or not, etc. and you can’t see/smell who is vaccinated or who has washed their hands properly.

To point 2, that would be great data for hospitals to report, along with hand hygiene compliance, infections rates, etc. I’m with the camp of hospitals that believe more transparency is required if we’re really going to see improvements in healthcare quality and safety.

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14 Marty November 26, 2012 at 2:17 pm

Hmmm. . . Good point about being able to detect smoke but not being able to detect someone who hasn’t had the shot. I do like your potential solution about a facemask – or maybe at the very minimum requiring them to wear a pin that says that they have not had a flu shot.

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15 Mark Graban
Twitter:
November 26, 2012 at 2:22 pm

That’s the approach at Virginia Mason Medical Center… requiring people to wear a mask at all times if they didn’t get the vaccine.

A pin might be a bit too scarlet letter-ish…

That said, hospitals need to do more than vaccinate people. They need to create systems/processes that allow enough time for staff to properly wash hands, gown and mask up as required for certain patients, etc. I see that all as a much more systemic issue (I wouldn’t fire somebody for not washing their hands before entering a patient room… I’d look for systemic barriers and work to address those, making it easier for people to do the right thing, etc.).
Mark Graban recently posted..“Unity in the Essential, Liberty in the Non-Essential…”My Profile

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16 lean champion November 26, 2012 at 2:29 pm

Hi Mark,

Firing employees because of a Lean initiative is NOT a good decision (standardization, safety, however you want to group it). It makes the (Lean) program look bad, derails enthusiasm, turns the culture against the program. 98.1% obeyed their employer and took the shot, however, it doesnt mean 98.1% are happy about it.

Furthermore, I dont believe vaccinating shop level emlployees is getting to the root cause of the problem (wait a minute, what is the problem here? why are we forcibly vaccinating employees? I’d like to see the A3 on this one. Somehow I doubt it exists).

If the hospital is worried about spreading flu/protecting patients then why are they not vaccinating every single person that walks thru the door? – patients & admits, UPS drivers, organ transplant runners, the 3rd party oursourced cleaning service, etc. Of course I am not serious, but I think you get my point. Patients can get flu from the ER waiting room from each other. So let’s force our employees (whos service we value) to get vaccinated possibly against thier will or ultimately fire him/her!! It doesnt make sense.

People can cite all kinds of statistics about the pros & cons of flu vaccine. I like to look at the studies performed by 3rd parties and not the vaccine manufacturers & the governments that subsidize them. Here was an interesting study to say the least:
http://gaia-health.com/gaia-blog/2012-10-05/no-value-in-any-influenza-vaccine-cochrane-collaboration-study/

I also take issue to the fact that the WHO, CDC inflate thier flu related death numbers. The CDC does not distinguish between deaths caused by an influenza virus and deaths due to pneumonia. The two are lumped together in their mortality statistics and pneumonia-related deaths are reported as having an initial influenza cause. I think these ‘command & control’ policies that hospitals put in place can try to be legitimized thru Lean philosophy (standardization & safety, possibly even customer satisfaction) but at the board level I’m think it’s more about: making sure big pharma makes record profits, mass conditioning, scare tactics, fear.

Thanks!

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17 Mark Graban
Twitter:
November 26, 2012 at 2:43 pm

There’s zero evidence that TriHealth and the firings have anything to do with Lean. You’re right, there’s probably not an A3.

At Virginia Mason Medical Center, there probably is (or at least there is probably better problem solving). Again, in their Lean culture, it doesn’t seem like they are firing anybody.

That’s why this is all interesting food for thought — both from a “Lean culture” perspective and just debating what’s right for the patients and the healthcare organizations, what steps we are willing to take to ensure safety, etc.

I did have one hospital client that insisted on records about vaccination for flu, Hepatitis, etc. (for my own protect and, I’m sure, for their patients). Every one-off visitor probably doesn’t get this, but they do ask people who are sick to wear masks or, better yet, not come.

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18 Andy Hoort November 26, 2012 at 4:21 pm

I strongly recommend to all interested in the subject of influenza that they “Google” a guy named Peter Doshi. He is a postdoctoral fellow in comparative effectiveness research at Johns Hopkins University School of Medicine. He is also an alumnus of MIT’s Doctoral Program in History, Anthropology, and Science, Technology, and Society (HASTS).

I ran across some of his research on the flu vaccine while in nursing school and found it very interesting. Especially, the efficacy rates of past flu vaccines.

Here is the link to his dissertation at MIT entitled Influenza : a study of contemporary medical politics: http://dspace.mit.edu/handle/1721.1/69811

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19 Mark Graban
Twitter:
November 26, 2012 at 4:27 pm

What’s the key takeaway on his research, for those without the time or inclination to dig through a dissertation?

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20 Andy Hoort November 26, 2012 at 4:56 pm

Hate to paraphrase a guy’s dissertation… but the 5,000 foot view, flu prevention has become a political rather than scientific practice, there is weak evidence for flu vaccines, but strong evidence for hand washing. Why don’t we put funds towards hand washing?

Here is a letter he wrote to the BMJ in 2008 after a Cochrane review of flu vaccine research came back with less than stellar results.

“Reason for optimism

The US Centers for Disease Control and Prevention (CDC) claims that the single best way to prevent seasonal flu is to get vaccinated each year. Such confidence in influenza vaccines seems misplaced for two reasons. Firstly, if CDC viral surveillance data are correct, then in recent years true influenza viruses have caused an average of only 12% of influenza-like illness (the syndrome the public thinks of as “flu” and, most critically, the syndrome the public is trying to avoid). Since influenza vaccine does not work against non-influenza viruses, how can the agency responsibly claim vaccines are the best way to prevent seasonal flu?

Secondly, the track record for influenza vaccination is not stellar. Over the past years, numerous reviews have shown that the benefits of influenza vaccination have been overstated-most importantly in elderly people, the group most needing protection.

With all the focus on influenza instead of influenza-like illness, we are missing the target, pursuing a health policy that has probably placed a prolonged undue reliance on vaccination and other pharmaceutical measures-and prematurely and (we now know) illegitimately demoting the role of physical barriers such as hand washing and masks. Official US recommendations for the prevention and control of influenza are 25 000 words long. Only one sentence of that document mentions non-pharmaceutical interventions, only to brush them off as having “not been studied adequately.” Jefferson et al have reviewed the literature-and the evidence gives reason for optimism. Will policy change?”

Peter Doshi graduate student, Massachusetts Institute of Technology, Cambridge, MA, USA

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21 Eden Takhsh November 26, 2012 at 5:24 pm

I would hazard a guess that not many (if any) of the healthcare workers that refuse vaccination do so for reasons similar to Mr Doshi’s.

It is very reasonable to cite literature and research and argue against the CDC guidelines. However at this time this is one of the bodies to which I and others look to to guide us in our care.

It is acceptable to believe and cite studies that show driving at 70mph in a 55mph speed limit does no harm. I doubt that citing those will get you out of getting a ticket.

Again I absolutely love listening to research backed arguments against flu vaccination but this is not the reason for workers refusing it.

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22 Julie November 26, 2012 at 5:51 pm

I currently have until Dec 1st to get my flu shot OR ELSE! Fortunately, my employer still allows a religious exemption from the flu shot. I have spent a great deal of time researching vaccines. The fact is there have been no double blind studies done to prove it’s effectiveness! Every time a doctor quotes a study that was done, I always challenge WHO funded the study. It is always funded by the drug company who manufactures the vaccine. The bottom line IS the bottom line for the pharmaceutical companies.

My religion is not against vaccines; however, it IS cannon law that with a formed conscious, I not allow harm be done to my body. It is my belief that vaccines cause more harm than good, and so far no one can prove this otherwise. To make you feel better about my care to patients, I do take great care of my immunity. I take vitamin D 3- 50,000 IU weekly, Omege 3′a daily, Vit C, Selenium, Magnesium, Iodoral, probiotics, and a few others. I’ve called in sick ONCE in five years. I’ve never become sick from caring for patients. I have 5 children that I’m around everyday.

I will have to wear a mask again this year through the flu season. The interesting part is the mask only draws attention to the fact that I don’t get the flu shot, which then gives me a platform to educate my patients on why I feel the flu shot isn’t for me.

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23 Mark Graban
Twitter:
November 26, 2012 at 6:15 pm

Not being sick or being asymptomatic doesn’t mean the flu isn’t being passed on to patients, right? If so, I’m glad that you’ll be wearing a mask. I’m glad that the “or else” means to wear a mask rather than you being fired.

The CDC recommends flu shots as a way of reducing transmission… are they bought and paid for by pharmaceutical companies?

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24 Marty November 26, 2012 at 6:26 pm

OK Mark,

I see some really good comments here. And frankly I’m being swayed in a different direction now. I would like to take this back to Lean and the first principle of respect for people. I know that the customer is important, but we can’t have that if we don’t respect people and their ideas. So. . . with that context, I’m thinking if I were in charge, I might do the following:

1. Spend a good deal of time developing a good measurement of infection rates at the hospital. Ensure that it is transparent, accurate, and reported regularly.
2. Set an acceptable goal and put that in everyone’s objectives.
3. Give them the tools to succeed. (i.e. lean tool training, access to coaches, time for daily improvement discussion)
4. Hold them accountable.

The flu shot may or may not be part of what the groups come up with. Let them do the A4, the research on vaccines, and the marketing to their peers about best approaches.

What do you think?

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25 Mark Graban
Twitter:
November 26, 2012 at 6:33 pm

Marty – I agree that’s a good high-level approach.

For #2, the only “acceptable” goal is zero hospital-acquired influenza (or hospital-acquired infections). The statistically “expected” rate might be based on the past few years’ worth of data (if we had it). I’m in agreement with Paul O’Neill that zero or 100% are the only goals worth setting (and this doesn’t mean punishing people for not hitting the goal).

The outcome is really what we want – zero patient harm.

That said, the CDC says flu shots are a big part of the standard solution. If we’re driving evidence-based medicine or evidence-based management, we have to take that outside input into account. This probably is too serious for everybody to figure it out on their own.

What do you mean by #4 “hold them accountable”? In healthcare, unfortunately, that means punishing people. With Lean, we take a different approach… rather than saying “hold them accountable” I’d prefer “review the process and the results and continue improving.”

We can solve this problem in a way that’s respectful of both the patients and the caregivers… if we go through an inclusive problem solving process rather than just having top-down solutions.

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26 Marty November 26, 2012 at 6:39 pm

Sounds like a plan to me. I guess by #4 I meant that not improving is not an option. “Reviewing the process and the results and continue improving” is the only option. What’s not acceptable is zero improvement and zero improvement activities toward zero infections. That’s when we will have to start having conversation about the “bus”.

I guess with this context, I’m increasingly believing that hospitals that force their staff to have vaccinations, but claim to be doing Lean activities are actually very “LAME”.

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27 Mark Graban
Twitter:
November 26, 2012 at 6:44 pm

In that whole process, Marty, it’s management who needs to be held accountable, not the front-line workers. They own the system and they are responsible for quality and safety, again, going back to Paul O’Neill and what he learned from Dr. Deming.

Again – in the context of today’s post, Virginia Mason is “doing Lean” and gives employees the option of wearing a mask. TriHealth (with or without Lean) has fired people.

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28 Marty November 26, 2012 at 8:12 pm

Re: TriHealth I know we didn’t say that they were doing Lean, but I just really wanted to include “Lame” in my post!! :)

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29 Mark Graban
Twitter:
November 26, 2012 at 6:34 pm

p.s. When I wrote this post, I knew there were no easy answers to this question. I really appreciate everybody’s input and respectful discussion today and beyond.
Mark Graban recently posted..Article on Lean Design and Evidence-Based DesignMy Profile

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30 Anonymous RN November 26, 2012 at 6:53 pm

I’ve been a nurse for almost 25 years. I elect to receive a flu shot each year. Receiving a flu shot is not mandatory at the hospital I work at, but it is provided free of charge. I believe that being a professional comes with responsibilities. For a nurse, that responsibility includes doing what is necessary to prevent weak, vulnerable patients from getting a disease or condition that was not present on admission to the hospital. Anyone with the flu can be asymptomatic in the initial stages and pass the disease along to others unknowingly. It is unacceptable for any health care provider to place patients at risk in this fashion.

I do not agree with firing health care providers who decline annual flu shots. There are hospitals in Washington state who mandate that employees either get a flu shot or wear a mask at work throughout the flu season. Either way, patients are protected. Protecting the patient is the bottom line. By the way, the hospitals I read about requiring employees to either receive an annual flu shot or wear a mask every day at work have an almost 100% compliance rate with annual flu vaccination.

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31 Andy Hoort November 26, 2012 at 8:13 pm

Just a devil’s advocate question…

Who exactly loses if we do away with the cost (manufacturing, distributing, and especially advertising) of flu vaccine and focus the funds towards 100% mandatory (and non-invasive) masks during flu season as well as improved hand hygiene?

Flu vaccination is only 50-60% effective and only against the specific flu strain. Masks and hand hygiene (when used properly) are much more effective and protect from other viruses and bacteria as well.

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32 Karen Martin
Twitter:
November 26, 2012 at 11:16 pm

Mark – You sure stirred up a hornet’s nest here! I’m with Brian – I’m VEHEMENTLY against requiring anyone — no matter what — to get a flu shot. It’s forcing someone to put a foreign substance into one’s body that has not been proven out across all circles (as Andy points out). No one asserts that taking vitamins is dangerous or ineffective, but there are many intelligent voices who oppose flu shots. Me thinks where there’s smoke, there’s fire. I’ve never gotten one and I likely never will. If my employer required it, I’d quit. No matter what. Seriously. It’s B.S. that an employer would require this — I don’t care what business they’re in. That’s not what freedom is founded on. And, to many readers’ points, it’s certainly disrespectful.
Karen Martin recently posted..Consistency is KeyMy Profile

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33 Mark Graban
Twitter:
November 27, 2012 at 12:33 am

There are MANY who say that taking a daily multivitamin is a waste, by the way.

One challenge in healthcare is the lack of 100% definitive evidence that’s not shifting or questioned.

But, the CDC says the best evidence we have today is flu shots are safe and help reduce the spread of flu. This has especially meaningful impact on elderly and disadvantaged patients.

I think it’s arguably selfish to say no to a small action (vaccine) that can save the life of a patient. First, do no harm?

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34 Karen Martin
Twitter:
November 27, 2012 at 11:10 pm

And we believe that everything the CDC is gospel why????

Sorry, but flu shots smack of muda to me. This is an ideological debate, similar to religion and politics. I’m bowing out.
Karen Martin recently posted..Consistency is KeyMy Profile

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35 Mark Graban
Twitter:
November 28, 2012 at 1:35 pm

It’s not gospel, it’s the best scientific knowledge we have at this point.

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36 Jason Yip
Twitter:
November 27, 2012 at 5:39 am

Perhaps require anyone who doesn’t get the flu shot to wear a visible tag so patients can request they stay out of transmission range.

http://www.sciencebasedmedicine.org/index.php/flu-vaccine-efficacy/
Jason Yip recently posted..A summary of Protocol Analysis: Verbal Reports as DataMy Profile

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37 Anyon Secretary in healthcare November 28, 2012 at 8:21 pm

and if we give away our freedom to question that very “all the scientific evidence we’ve got” about flu prevention, well… should I even continue? how can anyone so intelligent not understand the basic fact about any vaccine or medication is its NEVER 100% proven and ALWAYS has side effects. until we become more aware of the field of medicine and intelligent about it we cannot force people into something that is still being questioned.

The world was once flat remember?
someone with intelligence and freedom to explore his questioning of its certainty led to the fact we know now.

things are wrong. what if one day, far fetched as it may sound, they discover something about vaccines ingredients that IS linked definitively to cancer? diabetes? etc.

who knows.
and who doesn’t want you to know, and why?

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38 Mark Graban
Twitter:
November 28, 2012 at 8:27 pm

I know, cigarettes were once recommended by doctors. I get it.

This isn’t a matter of “freedoms.” Employment is a voluntary arrangement with a private entity. The government is not forcing the flu vaccination.

People are free to question the flu vaccines. But, given today’s scientific consensus, I’m not sure I’d want to be treated by one of those people. That’s my choice (not a right).

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39 Kopstar November 27, 2012 at 7:52 am

I’d just like to ask one question to all those who would flatly refuse a flu shot without getting into the human rights debate.

Would all those refusing a flu shot similarly refuse a recommended vaccine to reduce your risk of illness (or death) when travelling abroad?

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40 Sara November 27, 2012 at 10:26 am

Flu shots were mandatory at our hospital and in our entire hospital network. We are a small CAH in Iowa and affiliated with Mercy Medical Center – North Iowa and therefore, associated with Trinity Health Systems. We did have some employees that did not want to get their flu shot, however the alternative was worse for them. It seems that asking someone to wear a mask if they don’t get the shot was enough of an incentive to just do it! I do believe we offered the nasal spray as an alternative to the shot. I, for one, would prefer to protect myself, our patients and my family at home by getting the shot. Between me working in healthcare and having kids in daycare, we have enough germs in our home to contend with.

Thanks for the post, Mark! Love your blog – learn a lot from you and your experiences. :)

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41 Andy Hoort November 28, 2012 at 1:31 pm

Food for thought… by endorsing the use of a 50-60% effective vaccine instead of the higher efficacy (and increased protection) of the mask Hospital policy might actually be discouraging the practice that is best for the patient.

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42 Mark Graban
Twitter:
November 28, 2012 at 1:34 pm

I don’t think it’s “instead of.”

Hospital staff are required to practice hand hygiene (wash their hands) before and after any patient interaction.

They already have to wear masks and take other precautions when entering the room of an at-risk patient.

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43 Andy Hoort November 28, 2012 at 2:16 pm

In Sara’s post above and in your post about Virginia Mason both policies required 100% mask usage in lieu of a vaccination.

My point is: 60% (vaccine) < 100% (mask).

So, why not forgo the huge cost of the vaccine and stick to the relatively cheap masks.

It would be akin to forgoing the expensive (and needless?) technology of some of the hospital inventory systems available for a simple, manual, Kanban bin and card system as mentioned in the comments section of this blog in August…

http://www.leanblog.org/2012/08/counting-the-ways-to-solve-the-counting-problem-w-hospital-supplies/

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44 Mark Graban
Twitter:
November 28, 2012 at 3:30 pm

Ironically, a hospital person contacted me privately and wrote that masks lose effectiveness after two hours because of moisture from your breath, etc. So who knows if that is 100%. I’d lean toward a multi-prong strategy then perhaps.

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45 Lisa S. November 28, 2012 at 6:37 pm

I’m not against doing it. In fact, I did it this year. I just want to see evidence this policy is actually working and not a huge cost that’s really lining pharmaceutical pockets with little return on investment (i.e. patient lives). If it is for all the right reasons, where’s the clear evidence to support it?
Check out recent CBC story:
http://www.cbc.ca/news/health/story/2012/11/22/flu-deaths-crowe.html.
Who do I believe? I want to believe it’s protecting patients but I’m not sure.

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46 Mark Graban
Twitter:
November 28, 2012 at 7:58 pm

I’ve read many articles over the years about the LOW profit margins for flu vaccines.

I don’t think anybody is being greedy or getting rich off of these.

From this article:

“While there is great potential to make money off of the millions of people that do get vaccinated each year, Ferris stated that flu shots have such a low profit margin that many pharmaceutical companies refuse to make them.”

Mark Graban recently posted..Dr. Gary Kaplan’s Piece on Lean for the Institute of MedicineMy Profile

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47 Mark Graban
Twitter:
December 4, 2012 at 2:18 pm

I’m not trying to re-dredge up the whole discussion, but I found a discussion at http://www.allnurses.com:

http://allnurses.com/pandemic-flu/nurse-i-fired-525079.html

Many interesting comments there, on both sides of the issue.

One person commented that “Nurses aren’t allowed to call in sick” — well that’s certainly not good for patients, either. Hospitals need to be CONSISTENT in policies that are supposed to be good for the patients and/or staff.

“…a recent study found that only 29% of healthcare staff with symptomatic influenza took time off from work. The 71% who came to work were exposing their patients to an illness that could be deadly when added to their already compromised health”

If nurses are not calling in sick out of fear, that’s a problem.

One person shared a workaround (that one commenter called “fraud”):
People fake it by going to walgreens, paying (getting the receipt/proof) and then refusing the shot. “They know what is up.”

Other interesting comments:

Our facility mandates flu shots as well. You can get permission from your PCP not to get one and they will excuse you, otherwise you are fired.

If you are going to work with any immunocompromised person, I think you have an ethical obligation to be fully vaccinated.

You have the right to refuse a flu vaccine- by not working in healthcare. Unless a vaccine is contraindicated due to a medical issue, you are an irresponsible healthcare worker if you refuse a vaccine and you clearly have little regard for the safety of those you care for. It is absolutely nothing like being forced to take a medication. Medications affect only you. Vaccines affect those you care for. Many hospitalized patients cannot be vaccinated due to immuno-compromise, which is unfortunate because those are the patients who most need to be protected from additional illness. They depend on you to take steps that prevent you from becoming a vector…. The Joint Commission is looking at making flu vaccines among direct patient care staff accreditation criteria, more power to ‘em.

Another thought: I don’t think the reason we are mandated to take a flu vaccine is because our employers care about our welfare. If they cared about our welfare we would all be getting mandatory rest breaks, bathroom breaks, and uninterrupted meal breaks. Now that would be a first, wouldn’t it? I have worked many a 12 hour shift, that turned in to a 13-14 hour shift without so much as a pee break because of the acuity of the patients and one new admission right after the other.

I learned from reading the American Nurse Association position papers that the ANA is NOT in favor of mandating any kind of vaccination program for nurses. It’s against our rights of self determination and autonomy… Doctors can refuse to get the shot, however they are stilled allowed to make rounds in the hospital.

Note that Lancet, the world’s leading medical journal, just posted an editorial in favor of mandatory vaccination for all health care professionals.

I am for immunizations. I am not for employers bullying people into getting immunized. If someone is having difficulty coming up with a convincing argument… It is healthy, for a healthcare worker, to say, “Show me the evidence. Show me the proof.” It is up to employers to come up with civil, & convincing arguments, and to demonstrate leadership skills when convincing people to comply.
Mark Graban recently posted..#LeanStartup Conference 2012 Notes – Get Out of the BuildingMy Profile

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