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Navigating Fallout from the Johnson & Johnson Vaccine Pause

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When the CDC and FDA announced the recommended pause in use of the Johnson & Johnson COVID-19 vaccine, healthcare marcom teams were forced into overdrive, along with their operational and clinical colleagues. The announcement has had instant ramifications for patients and healthcare providers alike. It is causing fear among the 6.8 million people who have already received the J&J vaccine. It is confounding distribution of the J&J vaccine. It is perpetuating and reinforcing vaccine hesitancy. And, it is adding one more burden on an already-fatigued healthcare workforce.

Even as this story continues to develop and the list of things we don’t know runs long, we do know that your staff and patients have questions. And that doctors, nurses and provider organizations are the ones to answer them because they are the most trusted voices when it comes to speaking on healthcare issues. It’s wise to activate them in this moment.

As you communicate with your community and your employees, keep these seven actions in mind.

  • Be proactive, even aggressive. Pausing J&J vaccination administration comes at a pivotal moment in pandemic response. While this news is damaging, we should focus on the merits of other available vaccines to stave off an overall increase in hesitancy. As you craft your communications, lean into the rigorous safety precautions and robust real-world data cited by the CDC and FDA to instill confidence in the Pfizer and Moderna options. Don’t take on the responsibility of vouching for J&J’s safety. Do share, without minimizing the significance of the blood-clotting cases, that it was six cases out of 121 million Americans receiving any COVID-19 vaccine. That illustrates the extraordinary focus federal agencies are placing on safety. The adverse effects are frightening, yet, as one person we spoke with said, their discovery in the context of the J&J vaccine “is a testament to how effective our vaccine monitoring system is.”
  • Prepare your people. Your physicians and nurses will be peppered with questions about the J&J vaccine – from patients who’ve gotten one, to those who were signed up to receive one, to others who are reluctant to get vaccinated at all. Develop your talking points and FAQs to distribute across your organization, along with processes to ensure your entire system is providing a consistent message.
  • Centralize the inbound inquiries. Part of preparing your people is to avoid unnecessarily burdening them. Yes, educate your clinicians to answer questions. But also build out scalable systems to distribute information and respond to questions. Consider a call center to address frequently asked questions and handle scheduling changes. Post FAQs and your policies on your website and other digital channels.
  • Activate your government relations team. Reach out now to your state officials for the latest on their recommendations, requirements, next steps and timing. We’ve seen a patchwork of state requirements at every stage of the pandemic, and there’s no reason to believe this will be any different. Keep the lines of communication open with officials so that you can respond to whatever they say and do next.
  • Don’t get out ahead of government agencies. This isn’t the time to take an action before the CDC or your governor’s office mandates something else. You’ll be fielding enough questions as it is. Don’t put yourself in the position of having to explain why your decisions diverged from later guidelines. In addition, be mindful to balance communicating effectively on this issue while still upholding the CDC and FDA as owners and arbiters of vaccine safety.
  • Tune into your channels. This is a hot issue. People are talking. Keep a close eye on your social media accounts. Make sure your marcom and patient relations teams are listening across all your channels to flag questions or concerns and, as necessary, escalate them.
  • Be prepared to communicate about this. A lot. It’s not going away and, despite our best efforts, will likely affect the overall perception of the COVID-19 vaccine campaign. Questions and concerns will continue. Listen for clues that certain subpopulations (in this case, particularly women of childbearing age) may need tailored communications if they are ever found to be at greater risk for side effects.

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Running Through the Tape

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Spring is here, vaccines are out of freezers and in people’s arms, public venues are reopening and Krispy Kreme is handing out free donuts. Meanwhile, the CDC is still telling us to keep our masks on, the headlines look very pre-pandemic (and not in a good way) and new COVID-19 cases are twitching back up. So…are we allowed to be optimistic yet? In the latest with Kim Fox and Tim Stewart, we get real about “Hanxiety” and how far our obligation to others goes. We also talk about how our friends at hospitals and health systems can leverage the trust they have and help push us towards the bright sunny optimism that we’re all looking for.

Be sure to listen and subscribe to the podcast on Apple Podcasts or Spotify.

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This Isn’t a Church Potluck

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Sometimes the title of a podcast picks itself. Today, our two favorite outspoken insiders, Kim Fox, and Tim Stewart, take on the vaccine rollout. It’s been rocky, and there’s plenty of blame to go around, but there’s still time for hospitals, health systems and other healthcare providers to swerve around the potholes.

Be sure to listen and subscribe to the podcast on Apple Podcasts or Spotify.

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Now’s Your Shot: Boosting Hospital Employee Vaccination Rates

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It’s true: Some members of your clinical staff are reluctant to take the vaccine for COVID-19 they’re being offered.

What can you do about it? How do you respond when your caregivers – so influential to your patients — are hesitating to take what most healthcare authorities say is the very solution to protect our community health and lead us out of this pandemic mess?

Almost one-third of people living in households with someone working in healthcare are on the fence or unlikely to get the vaccine, per a new Jarrard Inc. national survey. The Wall Street Journal has also highlighted this issue, calling skeptical healthcare workers “an unexpected obstacle” to vaccine distribution. Meanwhile, the vast majority of Americans (79%) think hospital workers should be required to be vaccinated, according to our study.

Why the reluctance? Healthcare workers told us they’re worried most about potential side effects. But they’re also concerned they could catch the coronavirus from a vaccine or, simply, that the vaccines aren’t effective. They aren’t alone. Of the nearly half of Americans worried about COVID-19 vaccines, six in ten are concerned about side effects.

With the public overwhelmingly agreeing that the vaccine should be mandated for hospital workers and a notable proportion of healthcare workers skeptical themselves, the risk of tension between employee and employer and public is real. Will it matter when it comes to public perception of your organization or willingness for people to come in to receive care? Can public expectations be used to help encourage hesitant employees to get the vaccine?

Ideally, we can reduce the number of employees who opt out of vaccination through education and highlighting the positive outcomes. To get further, faster, consider these tactics for driving COVID-19 vaccine acceptance rates within your organization.

  • Listen first. Before developing any additional strategies, check in with your caregivers to learn more about what’s preventing them from receiving a vaccine. Some employees may still not understand how the mRNA vaccine works. Or they may have concerns about side effects. Quick due diligence through a pulse poll or leader rounding will give you valuable insight to better inform your plans.
  • Take another look at your process. While hesitancy is real, it’s also possible that your logistics are getting in the way of simple access. Is it hard for caregivers to register for the vaccine? Is it being offered in a convenient location? We spend so much time talking about access for patients, but in this instance, it’s important for our team as well. Make it easier.
  • Create a safe space for employees to get more information. By facilitating dialogue, you can provide employees with facts about the vaccine and answer their questions. Engage trusted members of your medical staff to lend credible, clinical voices to the conversation.
  • Celebrate caregivers who have opted in. As is the case with many organizational initiatives, your employees can be your best advocates. Highlight employees who have gotten vaccinated in internal communications or on social media. Sharing their stories and testimonials (including honest assessments of side effects, such as, “I felt lousy for a couple of days but I’m ok…”) can be influential for their peers.
  • Consider when it’s time to move on. At some point, providers who aren’t requiring their staffs to get vaccinated might need to stop putting resources into cajoling a resistant staff and applying that energy to others in the community. There is risk in pushing those remaining holdouts to opt in – risk in using valuable time and resources, risk in damaged trust within your workforce. Each provider needs to consider if and when a refocusing of effort should take place. Even before this happens, prepare to explain why you aren’t requiring employees to get vaccinated against COVID-19 (assuming that’s the case). Be ready to tell a public – who wants to see hospitals require vaccination – why you’re letting people opt out.

The good news is public opinion on the COVID-19 vaccination is increasing, and more Americans are expressing their intention to get vaccinated once eligible. By listening to your caregivers and meeting them where they are with the information they need, you can be in a better position to empower them to make the best decisions for themselves, their families and their community.

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Vaccines: Do you Know Any Sixth-Graders?

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Why you should practice your communications on a kid.

Situation: As shipments of COVID-19 vaccines roll out across the country and healthcare workers start rolling up their sleeves to receive the shot we’ve hoped and prayed for all year, there’s never been a more important time for hospitals to keep lines of communication open with the public. Providers have an opportunity and responsibility to be a visible source of truth in this critical phase of the pandemic. And the media can be a powerful ally for reaching the masses. Here are a few tips for engaging with reporters right now.

Quick Counsel:

  • Be comfortable getting technical. Mainstream media is now avidly covering topics tackled only by select trade journals just one year ago – such as vaccine storage and transport requirements, the differences between vaccines from various pharmaceutical companies and the particulars of double-blind studies. Be prepared to answer questions about the technical aspects of your vaccine supply and offer to show reporters the specialized freezers and other equipment you’re using to ensure a safe and timely rollout. Ideally, tap a clinical leader as your spokesperson for these interviews – a CMO, infectious disease specialist, pharmacy lead or infection prevention professional.
  • Make the technical more comfortable. Even though vaccine science is now a household topic, keep in mind we’re still communicating highly specialized scientific information with a lay audience. In general, reporters try to write for a sixth-grade reading level, so make sure your clinical spokespeople have received message training to keep things understandable. If you happen to have a sixth-grader handy, practice your messaging with them. If you can 1) keep their attention and 2) get them to explain the message back to you, you’ll know you’re right on target.
  • Set clear expectations. Without a doubt, this is a moment to celebrate. We’re ending an extremely difficult year with a glimmer of hope, and we want our patients to know that real help is on the way. But it’s important to be clear about what this joyous milestone does – and doesn’t – mean for our communities’ safety over the next several months. Don’t miss the opportunity to remind your audience about the ongoing importance of masking and social distancing. Help them set realistic expectations for when life might return to “normal.”
  • Start planning now for second-dose communication. We know we’ll need to convince our patients to show up for the vaccine not once but twice in 2021. So when working with news outlets about this first round of vaccines, talk to them about their important role in communicating that second dose later in the year. Reach out to your local editors and news directors to set a tickler on their editorial calendars for the spring. And do be sure to thank the  newsroom for their hard work this year.

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Taking a Stand: Healthcare CEO Visibility & Legal Considerations, with Michael Peregrine

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The expectations for healthcare executives have changed.

Hospital and health system CEOs are expected to take a stand on issues and to be public figures. Here, David Jarrard, CEO of Jarrard Inc. and Michael Peregrine, Partner at McDermott Will & Emery, discuss the changing environment for healthcare CEOs, the pressure on leaders to take a stand and how they can do that in a transparent way without stepping across legal lines. Between social change and the COVID-19 pandemic, the relationship between healthcare executives, their boards and their legal and communications teams is more important than ever.

Listen to the podcast, watch the conversation or read the transcript below.

Read the Transcript

David Shifrin:  Well, welcome to High Stakes from Jarrard Phillips Cate & Hancock. I’m David Shifrin. And today I am joined by our CEO, David Jarrard and Michael Peregrine, who’s a partner at, our good friends at McDermott Will and Emery. He’s an attorney who specializes in corporate governance and corporate structure.

And the genesis of this conversation came about because we’ve been looking at a number of different things. Michael has been thinking about the relationship between the chief executive officer as well as chief counsel, and the reason why that relationship is so important.

And what we’re seeing is that the CEO of organizations in general really need to be more visible now than ever. People are, as we know from numerous surveys, looking to leaders and executives for trusted advice and direction. And that’s very true right now in healthcare. In addition, people are beginning to expect more of CEOs. The idea of what a lot of people call a social impact company, like say Patagonia or a Tom’s Shoes, it’s shifting from sort of an outlier  to the mainstream.

So healthcare leaders in particular hold a unique position today because so much of society revolves around the pandemic and healthcare. And of course, healthcare should be by definition a social impact industry. We’re mission driven to care for people. So the question becomes in this current environment with COVID-19 and, you know, we’re preparing for a vaccine rollout that is happening as we speak, is how a healthcare executive sort of walks the line of taking a stand, both in terms of healthcare issues as well as larger social concerns and provide necessary information while not falling into foolish talk or legal liability. So again, I’m grateful to have you, Michael, and you David, join us for this conversation and really looking forward to what we can come up with.

Michael Peregrine: Well, David, you made it a lot of great points in your introduction.

I do think there is an expectation of CEOs to take more of a public position. And, you know, as David knows, in the old days CEOs kind of shied from the public venue, they shy away from major high profiles, and their board wanted them to shy away from a high profile situation. You know, it’s a great way to get in trouble.

As some, as the board members would say. All sorts of legal risks, disclosure problems, antitrust concerns. But David that’s changing. I started to notice this. I’m curious about your perspective, all of a sudden, you know, earlier this year we saw some of the corporate social responsibility conversations on gun control and immigration and some of those issues, but it seems like things began to change when CEOs started speaking out in November about the presidential election transition. And that started to morph into the period of the vaccine. And I was curious, are you seeing it the same way I am that this…all of a sudden the landscape is changing for CEOs and public commentary?

David Jarrard: Yeah, Michael, we, we are . I think CEOs are finding an opportunity to fill a vacuum of trust that exists in the community.

They recognize that because of who they are, and the organization they represent, they have some credibility, they have some strengths they can bring to the conversation, and many are taking advantage of that some wisely and some not so much.

Michael Peregrine: We’ve seen that a lot. And I guess one of the things that I always wanted to remind clients is historically, you know, who do they go to in terms of advice on what to say and when to say it and things of that nature? David, my view has always been, you better check with the board chair before you venture out there, but perhaps first, you know, CEOs look to a team of colleagues on their executive leadership team, the chief communications officer and the chief legal officer and touch base with them first.

And those are two folks who don’t usually communicate a lot. They don’t talk a lot or collaborate a lot on projects, but on this one, it seems like they ought to.

David Jarrard: Ought to, and more and more generally we would hope that a CEO or a leadership team would check with the communications officer because there is a communication strategy.

And you want the voice of your CEO or the leadership team to echo and support the strategies put in place, which is usually about building market share or providing a level of trust with customers and patients in your organization. What we’re seeing now are CEOs who are sometimes acknowledging the communication strategy, but sometimes going well outside of the bounds of the traditional strategy that they would be following.

Michael Peregrine: Well, that’s why I suggest they talk to the chief legal officer first, who also is the board’s chief legal advisor. And yeah, just kind of clear the way here and make sure that the CEO is now stepping into forbidden territory. But I think David, part of that is maybe sharing with the board and educating the board on, now might be the time for the CEO, especially in healthcare, to start speaking out on some of these issues. You know, it’s not just the vaccination, although that’s certainly the key thing, right?

You know, we forget about things like the social determinants of health the racial disparities in delivery of healthcare. There are a lot of issues on which they ought to be speaking about.

David Jarrard: There’sa lot of issues that they ought to be speaking out on, and they have a unique opportunity to speak out.

You know, David mentioned early on a number of surveys that reflect the level of authority or credibility that certain voices have in the community. We’ve conducted some of these surveys ourselves. And one thing we certainly find, particularly on healthcare issues, is that hospitals and local hospital leaders,  physicians, and nurses have enormous credibility, enormous power to influence how people think, and that the community is looking for these people to speak out on these issues.

So it’s an opportunity, but it’s also a responsibility we would argue for these mission-driven organizations to speak out on the things that they have credibility on.

David Shifrin: David and Michael, I wanted to expand on that a little bit, because, so here the firm, we talk about an idea of responsible transparency and Michael, in your article that you wrote for Corporate Counsel that just came out on the relationship between a CEO and CLO, you use this phrase “right and legal,” which I think is kind of a similar idea to responsible transparency. But  you both are talking about sharing the right information. What does that mean, both in terms of the communications and being proactive and offering information, and then also legally, you know, right versus legal. And how do you, how do you balance that?

Michael Peregrine: Giving credit where credit was due. The concept of, the questions of, is it right? And is it legal? Are the basic questions that the chief legal officer is expected to ask. The modern chief… chief legal officer. That’s a concept that can be attributed to Ben Heineman, the esteemed former general counsel of General Electric for many years. And his point was you’re more than a technical legal expert. You’re a business partner to management and you’re a voice of responsibility and conscience to the organization. And I think, David, that’s where some of these issues come up.

You know,  the thing that jumped out at me as today as we’re taping this is, you know, this confluence of the vaccination. I was talking to clients today where the vaccine had arrived at their institutions today. We have that, we have Dr. Fauci, his comments about the need to have up to 75% of the population expanded.

And then you and I both were reading the same stories in The Times today about certain voices out there saying this is a communist conspiracy. Right. Don’t do it. Yeah. It’s, so, the question of, is it right? Is it consistent with the mission? That’s a conversation, David, I think that the CEO ought to be having with the board chair and the general counsel.

I think that falls in the category of, is it right? And then how do we make it legal?

David Jarrard: Michael, I agree. And I love your emphasis on the CEO engaging with the board. Because many of the boards we work with, the health systems of course are representative of their community and  reflect a public mission of, often, a public health mission to advance public wellness in their organization.

And they do that through the operation of their health systems, but they also can do it by being strong advocates in this case for the vaccine and for other things that would cause population health to be improved  in their community. But it’s right that the board ought to be aware and an endorser of the CEO’s actions.

I think sometimes the challenge is, is when the CEOs and other leaders go off the reservation and they lose some credibility when they speak about the things that they are not naturally connected with. Right.

Michael Peregrine: We’ve seen some examples in our industry  where that has occurred and the board has acted swiftly because of the damage to the institution.

And that damage, David, I guess, could be immediate, can’t it, with the wrong kind of public communication.

David Jarrard: It can. Reputations are, are, are hard to build and they can take a lot of time, but they can be quickly dismantled.

Michael Peregrine: How do you handle that, David, when you get a call from an institutional client that says, “I have to respond to this comment on vaccination, that’s so contrary to what we need and must do. I need to get something out right away.”

How do you slow him or her down? What’s your course. How do you approach that conversation in terms of structuring the communication such that it doesn’t risk the CEO or the institution.

David Jarrard: You, you start with the core of your organization. You’ve got a mission, you’ve got a purpose and everything you say ought to be reflective of that.

Even if it is controversial with some opinions in the community it needs to reflect who you are as an organization. The board is truly helpful in helping define that. That’s thing one. Thing two is, there’s very few issues that are going to be raised that are a surprise. It’s not a surprise that vaccines are controversial. It’s not a surprise that this has been politicized issue like masking throughout pandemic. Smart communications officers and CEOs will have run scenarios, anticipated the questions that are going to come and be able to lean into them swiftly when the question comes.

Michael Peregrine: Are there limits to the venues that you would recommend a CEO use to set, send this public health message, social media versus print interviews, things of that nature?

How do you structure the communications plan?

David Jarrard: If it’s a question of the CEO speaking, you want a voice where the CEO’s message can be delivered in full. RIght? Those personal interactions. Those in-person engagements are the most powerful and the most persuasive. Social media is great, but  it’s like a loose cannon ball running around on a ship, hard to control.

And you have no idea what happens to it afterwards. So they can be a supporting actor there. And I, and I think it should be because so many people get their information there, but you’ve got to start with a core message that comes through personal engagement.

Michael Peregrine: And that’s the hope where you… that the chief senior communications officers are going to reach out and say, we also have to touch base with the chief legal officer and vice-versa and David Shifrin this goes to the point you raised, and this is one of those situations where collaboration horizontally in the C-suite between these two senior officers. And they work together from time to time. But really, it seems to me, David Jarrard is acute. You they’ve got to know that both they, they both have jurisdiction over the issue, that they both have a message to say, and they continue together. One going forward on this issue without the other in tow, it seems to me a real risk.

David Jarrard: I love your phrase that both have jurisdiction. We think of it in terms of like a political campaign where you have a variety of interests who are in charge of pushing the organization forward and pushing this message forward.

And these different voices need to be working together in tandem all the time, particularly in a moment of heightened scrutiny, like this, and heightened exposure like this. It ought to be not an occasional conversation or just a board meeting conversation. They need to be talking every day, emailing each other back and forth every day about what has, what has been, what is coming and what can you expect next?

David Shifrin: Something I’d like to highlight here. You’ve both touched on, but I think it’s really worth calling out is there may be issues that are legal. But, and again, this goes back to right and legal and responsible transparency, but there needs to be that, that communications perspective about how you should say it.

Or whether you should say it at all and the reverse is true. Right? And so having everybody in the room at the same time. I know David, we’ve got colleagues here who are strong advocates for having, you know, marketing and communications folks at the table in the room when operational and strategic, and in this case, legal decisions are made.

So they can be there to provide a perspective on how that might be… that message might be received as well as to craft the message in real time.

Michael Peregrine: Well, then those are messages, for example, the chief legal officer may be completely unaware of some of the critical concerns that David and people in his area are aware of and vice versa.

Historically again, this goes back to why CLOs have, have advised CEOs to be very wary of public communication. The potential impact that they may have in terms of sharing confidential information, the perception there’s somehow signaling anticompetitive messaging to within the organization or to colleagues or other organizations, they are somehow sending a message that’s antithetical to their charitable or tax exempt purposes.

If they’re a charitable organization or that they’re saying something that could have a dramatically negative effect on ongoing negotiations with the business partner, that’s the CLOs world. David but what does the CEO need to know from, from you as to things that he or she should be considering as he or she evaluates his advice to the chief executive.

David Jarrard: Well, I’m ticking in through my head the number of issues that just your comments have raised with me already where the CLO needs to be a partner in the conversation. I mean, right now we’re having any number of conversations with leadership teams who want to know how to talk about the vaccine and generate such a, such a conversation that causes vaccine hesitancy to be reduced where people feel confident about taking the vaccine. And sometimes the emotional reaction is just to provide an unambiguous assurance. “The vaccine is totally and utterly safe.” I hope that… I hope that would scare a CLO. We don’t want to hint in that direction.

Michael Peregrine: Yeah. Well, I think that the, the other issue is that the CLO would benefit from discussion from the chief communications officer of the real impact. What you think of a CEO coming out and speaking, as opposed to the chief of the medical staff or some other clinician or researcher, how would you describe the impact of a message from the CEO of a major metropolitan academic medical center in this issue?

David Jarrard: It’s different in every case. And clearly when we’re talking about vaccines or clinical issues, the clinical leader has much more credibility and authority from which to speak. Nurses and doctors are powerful spokespeople when it comes to the delivery of medicine.

Sometimes the CEO needs to speak because it’s a business issue or the CEO is speaking to his or her staff and colleagues in an environment, which we’re in now, nurses and physicians are looking for the leadership team with their organizations to have their back.

They get frustrated that the experience they’re having in the hospital of watching people die from COVID is not reflected when they go to Walmart or go to the grocery store and they see a community not having the same experience. And so they’re looking for leadership teams to speak for them, to have their back in those conversations.

And it’s an opportunity for CEOs to do the right things for their internal audience, as well as their external audiences.

Michael Peregrine: How does that relate to the upcoming decision that many institutions are going to have to take about whether or not to mandate vaccination. Who delivers that message? And what does that look like?

David Jarrard: It’s a great question because it needs to come both from the clinical voice and the voice of authority and the leadership of the organization. The clinical voice needs to say “here’s why medicine and science tells us this is the right thing to do.” The, the CEO has a, has a business decision to make.

And frankly, to your point earlier, both llegal exposure, labor exposure, any number of exposures that have to be considered as they take a position like that. And I would hope that the board is involved in a decision like that because of the trailing consequences about it in the organization itself.

David Shifrin: Michael, can you talk a bit about that legal exposure that could arise from those decisions as well?

Michael Peregrine:  It’s a fascinating topic, David and  it’s one of those things that the lawyers love to hate, which is it’s a muddy situation. It’s absolutely, going to David Jarrard’s question, a board issue.

Ultimately, that’s the kind of a decision that has such stakes. You can’t ask management to make it alone, and there are a number of factors the board’s going to have to take into consideration. Number one is obviously the, what is the right thing? What are the public health implications? Right? What is the value of to the organization and its workforce from mandating vaccination How do you prove it?

But I think the legal issue in where the CLO comes into play is the question of, okay. There’s a basic… the law basically says you have a duty to make sure of the health and safety of the work first and that the workplace is free of hazard. And that’s the way the organizations have previously put out mandates on other elements of flu.

This, it gets complicated though. And David, this goes to your area. If you have large sections of your workforce that are a part of an ethnic or religious group that has, that has real fundamental problems with the concept of vaccine or distrust with the vaccine, how does that work out?

Again… and then the following question or issue is, how does that play with your community? Is a mandate seen as authoritarian. And then what are your legal exposure in terms of the corporation as a board, will you be sued for issues arising out of the vaccination? None of those are – other than perhaps the legal issue – the issue of whether or not you have the right to do it is a up or down concern, David or a lot of those other issues go to the kinds of things you were talking about.

What do you, what is your knowledge base about the, your workforce? What are the community views on this issue? What would be the impact on the consumer? If you say, “we have made a decision at ABC medical center to require our employees to be vaccinated.”

David Jarrard: It is as you know, Michael, it’s not an insignificant issue.

And the latest surveys tell us that 36%, I think of nurses say they are very hesitant about taking the vaccine and in fact do not plan to take it. And so would you as an organization require 36% of your nurses to take the vaccine or leave? It’s a challenge for hospitals and health systems because they can’t afford to lose the nurses. We need every single one that we have. So it becomes a stalemate on with both a labor issue and a philosophical issue for an organization. Not a small topic. The hope is that as more people take the vaccine, they’ll see its efficacy. And they’ll say that it is being able to be received without side effects. And over time it’ll become accepted, which we’re not there yet.

Michael Peregrine: To both of you. That, from my perspective, advising client boards say, be prepared to make this issue. Be prepared to move swiftly, start to have these conversations in the evening, don’t let it wait till after the holidays. Recognize the public health concerns, recognize these frightening statistics about  the resistance to the vaccine and start to prepare your CEO for the kind of communication plan that you need to, because this all goes to the kind of back to where we began, David.

And that is, we’re in an environment now where I would say business leaders generally, and certainly in healthcare, are going to be expected to be engaged more in, uh, have with the public profile.  David Jarrard, you’re lead… your concept of leadership,  it is part and parcel of a values based company portfolio. I would say, consistent with these concepts of social responsibility.

Would we be having this conversation three years ago? Probably not. But, it neatly fits within where corporate purpose conversations are going. My message, again, fellows, is boards need to be preparing tonight to start that conversation. So they’re positioning their CEO to work with their communications consultants to clarify the, their legal rights, and to get those messages out before the window of vaccination opportunities past.

David Jarrard: Michael, I think that’s so smart. And, I think it’s smart, the boards being prepared, and I think it’s smart that boards need to be prepared tonight. Because we’ve been talking about the CEO and the leadership team as being the spokespeople. But as the boards, particularly of our not-for-profit hospitals, go out into the community, they’re the spokespeople.

And they have incredible power as they speak in their, within their church circles, within their grocery circles, with their social circles, what they say matters. And if it’s, if they’re saying something that’s consistent with their organization, they can advance it, but it’s easy for that to be disrupted and miscommunicated.

So then they need to be as consistent as the CEO in what they say and what they talk about.

Michael Peregrine: And David, are you concerned as I am that if they don’t make a decision and act on this relatively soon, the voices of those who were on the… on the fringe, the voices that we are reading about now that are saying this, this is a conspiracy, this is an awful thing and urging the public to reject the vaccination, that those voices will become accepted more broadly by the population.

David Jarrard: We cannot create a vacuum that allows those voices to be the only voice that is heard. Our belief is that hospitals and health systems are the original purpose-built organization. And we have a responsibility as boards and leadership teams to exude that purpose in our communications and messaging, particularly right now.

You’re, you’re exactly right, Michael. We’re at a key moment, a turning point moment. The pandemic has been raging for 10 months. We now have a solution, a reason for hope. We have to endorse that hope. We may not be able to fully explain everything, that is how it’s going to work and how it’s going to roll out over the next six months.

But if we can lend our own emotional voice of support, we will have a quicker and a better outcome.

David Shifrin: Well, thanks so much to both of you. So, move quickly but thoughtfully, have those conversations tonight. The board needs to be involved. Any other, you know, very specific action items that healthcare leaders should take home right now. And, and …either that you’ve covered that you want to highlight again, or that we haven’t covered.

Michael Peregrine: You know, David, I would say that it doesn’t have to be the CEO there. I’m sure there are CEOs who prefer not to have a public profile who are by nature people who like to operate outside of the public glare and David Jarrard, in that instance  who’s the default? Is that the board chairs and the chief of staff? We, we don’t want to put this all on the CEO, even though that’s the logical person.

David Jarrard: It should not all be the CEO. The clinical voices here are powerful. Your chief medical officer, your chief nursing officer are valuable. Also what’s valuable is somebody who’s good at it. Somebody who’s comfortable at it, Michael, to your point, they… somebody who’s passionate about it, but can’t deliver that message. It’s not really helpful. So it’s a role of the communications officer to train those key leaders up to play that role.

And as I said earlier, board members, whether they like it or not are spokespeople, so they’ve, they’ve got to be equipped and trained.

Michael Peregrine: And David, I would go beyond this, the particular immediate issue of vaccination. I would say that there are others we want to keep in mind. There are other public health issues on which CEOs really need to be speaking out on. We forget about them with the pressure of the pandemic,  but DavidJarrard, the, you know, there’s so many other things that have occurred this year that require our attention and require CEO attention.

We don’t want to miss those.

David Jarrard: You’re exactly right, Michael. And it’s, it’s not a secret what those are: the racial inequities and price transparency and surprise billing. We could go on and on with the list, but so can any other leadership team in a healthcare organization, and there’s no excuse for not writing down that list, coming up with your answers for that.

So you’re prepared when the time comes and when the questions comes. Because they’re coming.

Michael Peregrine: Especially when you see alternative views expressed on media outlets from ranging from 60 Minutes as it was last Sunday to, to social media, to the newspapers and things of that nature. It’s a different world for CEOs now, isn’t it?

David Jarrard: It is a different world. And we have to be prepared to answer those alternative views that are responsible in a way that’s responsible. We also have to be prepared to know how to deal with the crazy, cause the cazy is coming too, and it deserves something or nothing from us. We need to make those decisions instead of in the moment.

Michael Peregrine:  I thought we were done with that stuff!

David and David. Thanks very much.

David Shifrin: Thank you, Michael. Thank you, David.

David Jarrard: Thank you.

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Third Wave Rapid Response: Responsible Transparency

Large text that reads "Third Wave" with smaller text beneath that reads "vaccinations" on an orange background with a yellow wave

Situation: All eyes are on hospitals. And, by extension, you.

As the healthcare industry begins mobilizing for the massive vaccine push, every move that providers make is under scrutiny. Yes, caution is warranted. But you can’t be cagey. In this tense moment, you must carefully calibrate words and actions to provide clarity without going too far.

Quick Counsel:

Our most important communications advice here: Don’t make promises or statements that suggest your organization has signed off on the safety of vaccines. Instead, cite authorities and couch safety statements in terms of the information you’re relying on from other others: “We only recommend vaccines that are deemed to be safe by their developers and the CDC…” Then, explain what those organizations have found and how they reached their conclusions. Don’t put yourself in the risky position of affirming safety – talk to your counsel to see where you could end up with legal liability.

Other tips to help you walk the line of responsible transparency:

  • Bring your Communications team to meetings with legal. We’ve long advocated for including marketing and communications in operational, strategic and patient experience meetings so they can help inform the decisions and understand the messages they’re being tasked with promoting. In this case, it’s particularly critical to have this team understand the legal nuance. Moreover, your marcom team can help translate and package legal information so it’s not only accurate but also engaging for the end user – telling your story and advancing your mission.
  • Be open with what you know…and don’t. Even if it’s uncomfortable. It’s pretty simple: If you look like you’re hiding something, people will assume you are. Communicate early, often and clearly. Offer whatever detailed information you can and explain why you can’t share the rest. (“I’m sorry, we’re unable to provide specifics there due to patient privacy.”) Don’t let others tell your story for you.
  • Train your spokespeople. Equip anyone with a public-facing role with the right tools and messages. We frequently note that getting the messenger right is as important as getting the message itself right. But don’t take that to mean the message isn’t critical. Prepare specific talking points, find time for media training and update everything as frequently as possible to keep people in line with your policies, procedures and legal considerations.

Don’t shoot yourself in the foot. Consider this: A $15 billion merger was just wrecked because a CEO bragged about leaving his mask at home. Foolish behavior won’t be tolerated – whether that’s hypocrisy from leaders or legally loose promises. Be careful, be responsible. Think before you speak.

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Vaccines: Having a Strategy When There is No Strategy

Large text that reads "Third Wave" with smaller text beneath that reads "vaccinations" on an orange background with a yellow wave

Situation: There’s no comprehensive national strategy for vaccines.

Yes, HHS, CMS and DoD have developed a skeleton plan for distribution and monitoring. But there’s no unified playbook for getting hundreds of millions of Americans inoculated against SARS-CoV-2. Detailed decision-making has been left to states. Some have chosen to be hands-on in their recommendations and others are taking a back seat, tossing the operational hot potato to providers themselves.

The resulting patchwork of guidance complicates the already daunting task facing healthcare providers charged with the quick and efficient administration of whatever doses are allotted to them. With that responsibility and a compressed timeline, we turned to Roger Ray, M.D., the chief physician executive at The Chartis Group, for how healthcare executives can act quickly and responsibly without clear guidance. Then we added a couple of notes regarding the communication of your plan.

Quick Counsel:

  • Check in and check around: Quickly create and maintain open communication channels with nearby provider organizations and community health entities. It benefits everyone if you can achieve consistency at the community level.
  • Don’t stop at the state line: Many provider organizations have patients or employees or both in more than one state. Be sure to align, if possible, with the distribution plans of your neighbors.
  • Look to the literature: When all else fails, base decisions on published studies and guidance concerning vulnerable populations.
  • Take good notes. In the absence of clear guidelines from state or federal agencies, bring together your executive, operations, clinical, marketing and comms teams to make a plan. Your people are well trained and will make the best possible decisions. Be confident in that and record your thinking so you can defend it later.
  • Communicate your strategy…whatever it is. Tell your story. Those notes you took? All of this is happening so fast, and everyone is affected, so people (everyone – the public and your employees both) will want to know what decisions you’re making about who gets doses when – and how you arrived at them. Bottom line: If you don’t talk about your strategy, someone else will.

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Vaccines: Show AND Tell

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”Do as I do, AND as I say.”

That might as well be the motto of healthcare’s efforts to guide the U.S. population towards rapid adoption of a COVID-19 vaccine.

With doses about to arrive, common sense would suggest that hospitals and health systems prioritize vaccinating frontline workers in direct patient care roles before healthcare industry leaders and administrators working from their guestrooms or offices.

Or does it?

Though many Americans are anxious to be inoculated, many are skeptical – including healthcare workers. We’ve heard this firsthand from our clients, and a recent survey found that 67 percent of healthcare workers intend to delay vaccination. Asked if they would volunteer for a COVID-19 vaccine, two out of three nurses polled by the American Nurses Association poll said “no” or “unsure.” So, it’s a tough sell. Allowing someone to move to the front of the line does no good if they don’t accept the invitation.

The solution might just be to find someone else to go first.

Last week, three former U.S. presidents announced they would take the coronavirus vaccine on live television to inspire public confidence in the immunization. Healthcare system presidents should consider doing the same for their people. If health systems are encouraging caregivers to take the vaccine, there’s no better way for their leaders to communicate confidence in the science and reassure their team of vaccine safety and efficacy than by taking a vaccine themselves.

Otherwise, the risk is caregivers asking their executives: “Well, if you won’t get it, why should I?”

As doses are shipped, health systems grappling with a reluctant workforce should weigh the potential benefits of a similar gesture. How to go about this?

  • Identify your organization’s most trusted leaders related to the pandemic. Is it your CEO? Your chief medical officer? Your chief nursing officer? Your infectious disease experts? Would trusted leaders receiving the vaccine inspire confidence in your clinical workers?
  • Develop an effective communication strategy. How might you communicate this step? Perhaps a memo or a video message from leadership would be effective.
  • Weigh the implications. If you receive severely limited doses of the vaccine and are seeing high demand among your clinical workforce, would it send the wrong message to allot any of these to non-clinical roles?
  • Continue to set an example in other ways. Even if your system decides not to provide the vaccine for key leaders, leaders should serve as role models for how your team should behave in other ways, like continuing to wear a mask, wash hands and practice physical distancing.

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Planning for the Unthinkable – Again

A distressed healthcare worker in scrubs sitting against the wall with head in hands

On April 16, I wrote about the need for hospitals to plan for the potential of invoking crisis standards of care. Put another way: rationing of care. Eight months later, that frightening and tragic possibility has returned to the forefront.

Hospital leaders must act now as some areas of the country are running out of ICU capacity. We are experiencing record-setting numbers of cases and hospitalizations nearly every day, with no end in sight. “Informal rationing of care” has been noted in Utah, and the possibility of “thresholds for admitting patients to hospitals” shifting was recently raised by Melanie Evans in The Wall Street Journal. Other states, including New Mexico and my own state of Idaho, are close to the edge.

Despite loud warnings, there’s no indication that the growing spread is causing alarm or inducing Americans to dramatically alter their plans – including holiday travels. Yet based on what we know about the virus and what we observed following Canada’s Thanksgiving in mid-October, there’s every reason to expect the surge to grow over the next couple of weeks.

As if this weren’t enough, we’re also bracing for the annual influenza epidemic. CDC numbers show 140,000 to 810,000 influenza hospitalizations each year in the past decade. This year, we also have the specter of co-infection with influenza and COVID-19, resulting in more severe disease and poorer outcomes.

All of this could serve as the tipping point for many hospitals currently strained by large numbers of staff in isolation or quarantined due to the virus. And, unlike in April when COVID-19 flare-ups were regionalized and resources could be redistributed, there are fewer options for moving healthcare workers into or patients out of hard-hit areas at a neighboring hospital or state.

In short, we must mobilize now. Here are seven points to consider:

  1. Know your state’s crisis standards of care. Ensure that your physicians and staff are familiar with your state’s standards and are prepared to implement them should the time come.
  2. Keep your board up to speed. Ensure they understand how dire the situation is becoming and what the implementation of crisis standards of care will mean for the hospital and your community.
  3. Communicate with your community. The public may not understand exactly what rationing of care means or its full implications. People probably aren’t aware, for example, that your bed capacity is not your number of beds but the number of beds you can staff. They likely think that hospitals can simply hire more staff, open more beds or create field hospitals. And, critically, your community may not realize that capacity constraints don’t just apply to COVID-19 patients – the lack of staffing and bed capacity can affect availability of beds for patients with heart attacks, strokes or trauma injuries. Without proactive education, you face the strong likelihood that the public will react negatively to hospitals for failing to warn them and for failing to take steps to prevent this.
  4. Arm your clinicians with messaging. Make sure that you have specific doctors and nurses prepared to carry the message on media and press interviews. Your communications staff should also be prepared to respond quickly to social media.
  5. Clarify who will make triage decisions. It’s wise that this is a team effort, not an individual. Placing responsibility on a single person comes with risk. First, that person could become ill and unavailable. Second, one person should not bear the weight of care rationing decisions. A team can provide support and lessen the burden. Finally, you could be operating under the crisis standards of care for a while. Even if your state were to implement mandates at that time or other public health orders, it likely would take weeks before the pressures on hospitals was relieved.
  6. Stay in touch with your insurer. Be sure that your general counsel reaches out to your liability carrier to notify them of this impending event given the potential for lawsuits. Hopefully, your state has enacted liability protections in association with a declaration from the governor that crisis standards of care are in effect.
  7. Be empathic. Have a game plan to provide emotional, spiritual and psychological support to families, staff and physicians during the time of these decisions. Families of patients who will not receive every intervention possible will no doubt be angry. Staff and physicians who have to make these wrenching decisions or who will be providing comfort care to patients who would in other circumstances would have received aggressive treatment may suffer tremendous discomfort and discord in not being able to do everything possible for every patient.

I hope this can be averted and that your preparations for crisis standards of care will not be needed. However, with each day, I grow increasingly concerned. This will be a dire time and the most challenging of the entire pandemic. This time will test your leadership like no other. I am praying for you, your physicians, your staff and your communities.

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