Babcock notes that it's probably even more important that communication of a mandatory policy is very clear and is presented to employees early in the year rather than weeks before flu season.
"As soon as you decide this is what you are going to do, [it's important] that you start talking about it and publicizing it and making it clear what the process is for an exemption, that you have people available to talk to those who have concerns about the vaccine so they can have their concerns addressed and alleviated in a timely and reasonable fashion," she says.
Ultimately, BJC terminated eight employees—two worked in information services in the corporate offices, and the other six included a patient care technician, a paramedic, a laboratory technician, a nurse, a sitter, and a physical therapist.
Using exemption forms
One of the most important aspects of the mandatory vaccination policy is ensuring that there is enough room for medical and religious exemptions.
Babcock recommends developing a form that lists medical contraindications for exemption (e.g. egg allergies, previous reactions) rather than an open letter from a doctor.
"We got a lot of letters that didn't give us enough information for us to make a decision. With forms, it's a little bit easier to have that information in front of you," she says.
Religious exemptions required a written letter from the employee that stated a religious conviction opposing the vaccination. That letter was reviewed by HR, and employees were notified within five days if they were exempt.
Timing is everything
BJC was fortuitous and perhaps a little foresightful with the implementation of its mandatory policy. Because the health system implemented the policy in 2008, before H1N1 emerged in April 2009, it easily rolled the H1N1 vaccine into the requirements once it became available.
"Again, that went pretty smoothly, but by that point we already had a mandatory program, so people had sort of wrapped their minds around that to start with," Babcock says.
However, healthcare facilities that are considering a mandatory vaccination policy for the 2010–2011 flu season won't run into the problem of forcing employees to take two shots. On February 22, the FDA decided to follow the World Health Organization's advice and fold the H1N1 vaccine into next year's seasonal vaccine, meaning there will be only one shot for both viruses.
This, coupled with increased attention to pandemic influenza and patient and worker safety, could mean mandatory vaccinations are the future.
"I think that there is increasing expectation that healthcare workers will be vaccinated, and it's becoming more and more of a patient safety issue, similar to other vaccination requirements for healthcare workers," says Babcock. "There are just certain duties that as healthcare workers we take on to protect our patients, so this is just becoming one of them."