Mandatory Flu Shots: A Defining Moment

It was big news back in 2005 when Virginia Mason became the first medical center in the United States to require all employees to receive immunization against the flu. The recommendation came from a rapid process improvement workshop (RPIW) that featured about a dozen people including physicians, nurses, frontline staff and administrators across the organization.

A medical assistant on the 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?”

Joyce Lammert - Virginia Mason Chief of Medicine

Joyce Lammert, MD
VM Chief of Medicine

This was a radical notion at the time. Dr. Joyce Lammert, MD, chief of Medicine, was part of the RPIW team. She recalls the team embraced the idea, feeling that it called into question the organization’s commitment to putting the patient first. The suggestion was a perfect example of putting the patient first – Virginia Mason’s sacred commitment.

“We have one of the oldest patient populations in Seattle,” says Dr. Lammert. “So to not be vaccinated when you’re taking care of frail elderly patients is not acceptable.”

Underneath the flu immunization decision was a deeper cultural issue that involved really committing to put the patient first – in reality, not just rhetorically.

Dr. Lammert explains, “If you want to get down to the truth of it, many doctors, nurses and other providers, at the time, provided care that was more provider-centered than patient-centered. The flu RPIW helped us face the question – why are we really here?”

It was somewhat similar, she says, to the discussion a few years earlier – quite a difficult series of discussions – that resulted in the Virginia Mason physician compact.

“And so almost the same way we had the discussion about the compact, the discussion about mandatory flu immunization was really defining,” Dr. Lammert recalls. “It raised the issue – ‘do we really mean that patients are what we’re about?’”

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).

The publicity around the new approach generated multiple requests for information from other provider organizations around the country. Callers wanted to implement the same policy and invariably asked the question, “How did you do it?”

Dr. Lammert explains what happened and also cautions that it is necessary to have an aligned organization:

“You absolutely have to have an aligned upper administration, and you cannot turn back – you have to keep moving forward,” she says. “There were times when I thought ‘what if a large number of staff, particularly our frontline providers, from PCTs to MDs, refused? How could we run our hospital? What if an entire surgical team or hospital floor walked out?’ That made me toss and turn at night, but with Gary [Virginia Mason’s Chairman and CEO Gary S. Kaplan, MD] it was, ‘well, we’ve made this decision. It’s the right thing to do, and now we’re going to do it.’ That was huge. This was a patient-safety issue. It was a defining moment for us.”

What defining moments have you been part of in your organization?

Leave a comment


  1. Peter

     /  September 17, 2012

    After 7 years of having this policy in place, does Virginia Mason have statistics to show the effectiveness of vaccinating the staff? I am aware that many care providers suffer from sani-bacteritis or the belief that “my germs don’t harm people”. If there were some stats to show the correlation between vaccinated providers and infected patients it may go a long way to convincing people that everybody needs to participate to make a notable difference.

    • Thanks for your comment, Peter. Gathering statistics to demonstrate fewer ill patients or staff is very difficult because this is not a controlled study. Because we don’t culture everyone with flu-like symptoms (which can range from mild upper-respiratory symptoms to sick-in-bed symptoms), we don’t have definitive numbers of who actually has influenza as opposed to another viral infection. In addition, influenza severity varies from season to season, so differences in staff calling in sick or patients being hospitalized may be because of that variation. Studies done in closed systems, such as nursing homes, however, have clearly shown a reduction in influenza illness in patients when staff are immunized.

      Joyce Lammert, MD

      • Peter

         /  September 18, 2012

        Thank you, I agree it is very difficult to collect population wide data like this (especially with the challenges you identified) but I thought I would ask. Keep up the good work.

  2. Joanne Lynn

     /  November 1, 2012

    I’d like to hear more about the physician compact implemented in 2002 or 2003. I started working at VMMC (in a non-medical position) in 2005, so though I greatly benefit from this decision, I don’t know all the details, I don’t know much about how things worked before the compact, and, particularly, I missed out on the discussions. Such a huge task–how did the physicians accomplish this?

    My assumption is, again, dedication to the patient. I see this here every day, at every level of leadership. This is rare in an organization, but as we become more and more recognized as leaders in the industry, more and more organizations–I hope–will follow us to excellence. God knows the health care industry in this country must change.

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