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January 21, 2013

Hospitals Use Data To Boost Staff Vaccinations, Improve Care

Last year, UMass Memorial Medical Center reported that 60.6 percent of its health care workers had received vaccinations against influenza. Given that hospitals deal with a uniquely vulnerable group of people, and that public health organizations recommend that virtually all health care workers get the vaccine, Robert Klugman, chief quality officer for the UMass Memorial Health Care system, said the percentage was “disappointing.”

So the hospital instituted new policies, including requiring employees who didn't get vaccinated to wear surgical masks during interactions with patients. This year, Klugman said, the vaccination rate topped 96 percent.

Other Central Massachusetts hospitals have also been working to hike rates among workers. These campaigns show the growing use of quantifiable goals to improve the quality of health care, as well as challenges involved.

Deborah L. Wexler, executive director of the Minnesota-based Immunization Action Coalition, a nonprofit that works to increase vaccination rates, said the group recommends that hospitals mandate flu shots for health care workers.

“Hospitals realize their main objective is to protect the health of their patients,” she said. “You can't have a health care worker exposing a patient to flu.”

In recent years, governments have begun pressuring hospitals to get employees immunized. A handful of states have required the vaccine for all hospital health care workers, with some exceptions for religious or health reasons. Massachusetts doesn't have such a requirement, but it does collect and publicize the percentages that do at all hospitals, and the federal government has also begun collecting that data.

Tying Data To Reimbursements

The flu shots percentage is just one example of a growing mass of data that hospitals collect, whether to report to government agencies or private insurance companies, or simply for internal efforts to improve care. Various agencies collect and publicize information on everything from whether patients having a heart attack are immediately given aspirin — a practice known to improve outcomes — to whether patients report the hospital was quiet at night. Medicare, Medicaid and private insurers are now using some of this information to adjust how much they reimburse hospitals for care.

Tom Hijeck, vice president of nursing for Harrington HealthCare System, which includes Harrington Hospital in Southbridge, said the hospital pays attention to those kinds of variables, not primarily for financial reasons, but because the factors government agencies have picked as important are the ones strongly supported by science.

“I think you have to look at it that they're a proxy for giving the best care,” he said.

Even so, Hijeck added, hospital workers need to use their best professional judgment to determine whether any of the recognized best practices are appropriate for a specific patient.

Like UMass, Harrington has instituted a requirement that health care workers get flu shots or wear masks.

When UMass instituted the policy, some nurses complained. David Schildmeier, a spokesman for the Massachusetts Nurses Association (MNA), which represents nurses at UMass, called the masking policy “ridiculous” and argued it was a way to shame nurses into getting the shot. Schildmier said the union supports the goal of vaccinating workers, but voluntarily.

Similarly, he said, the union sees the value in many of the measurements third parties use to judge quality of care, but it opposes some methods the hospitals use to improve their numbers. For example, he said, some hospitals that want to raise their scores on patient-care surveys hire consultants to teach nurses and other workers to use particular phrases that have been shown to improve survey results. Nurses may be required to say “Is there anything else I can get you? I have the time,” even if that's not true, he said.

Schildmier said the best way to get to the heart of the quality issue would be to put more staff on duty so employees really would have more time.

Both UMass and Harrington said they don't ask their staffs to use particular phrases, but they train them in ways of speaking that have been shown to improve patients' experience.

Klugman said a big part of UMass's efforts to boost its quality measures involves more active participation. For example, he said, the hospital has streamlined cancer patients' visits by using the time they spend in infusion chairs to fill their prescriptions and explain the medications to them.

Michael Newstein, infectious disease physician at Milford Regional Medical Center, said the hospital has decided not to require masks for workers who choose not to be vaccinated, and has still managed an 87 percent vaccination rate.

Instead, he said, Milford requires workers who don't get the shot to take part in a special lecture explaining the issue's importance.

Figuring out the best strategy to handle the vaccinations is just one of many data-related challenges Newstein faces.

“Everybody is looking at numbers in my area, whether it's flu vaccination rates ... IV line insertion,” he said. “More and more, we're looking at these numbers.”

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