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When people do it right, it’s our duty to share.

The “doers,” in this case, were leaders at Penn Medicine. Their challenge was getting their workforce quickly vaccinated against COVID-19.

“Our flu vaccination each year isn’t an issue,” said PJ Brennan, MD, chief medical officer and senior vice president of the University of Pennsylvania Health System. “But for this, we had to be more persuasive. We needed an organized approach.”

In that statement, he spoke for virtually every healthcare leader across the country as they prepared for the COVID-19 vaccine rollout last fall and as studies starting last year revealed concerns about the vaccines among healthcare workers.

Penn Medicine’s approach to driving vaccine acceptance is worthy of a close look – especially for the way it connected with employees of color and groups with high levels of vaccine skepticism. And it offers lessons for other projects requiring employee buy-in that providers will always have to undertake.

How’d Penn Medicine do it? The short answer: It took a careful blend of operational nous and emotional intelligence. By May 2021, all of the health system’s employees and clinical staff had been offered the vaccine, and nearly 70 percent—more than 33,000 people—were fully vaccinated. That month, the health system was among the first, and the nation’s largest to date, to mandate COVID-19 vaccination for all its employees by Sept. 1 and for new hires effective July 1.

Taking Responsibility

Florencia Greer Polite, MD, felt the emotional weight of the pandemic from the beginning. An obstetrician, she was just settling into her role as chief of Penn Medicine’s Division of General Obstetrics and Gynecology when a close colleague got very sick from COVID-19. He was intubated for over 40 days, had a stroke and is now unable to operate on patients.

With that experience setting the tone for “the most stressful of my 20 years in medicine,” Polite considered the fall vaccine rollout. “I wasn’t sure when I was going to get the vaccine, although I knew I would eventually,” she said. “I’m not an early adopter by nature.”

But then she noted she was “a leader – and a Black leader – in this department and this institution. I considered what being at the beginning of the curve could mean for other people.” After hearing that vaccine would be arriving in mid-December, Polite ultimately leaned into her role over her natural tendency. “I said, ‘I’m getting it. I’m going to stand on the side of science and not fear.”

Not everyone in her personal circle supported her decision. Nonetheless, Polite joined a group of other Penn Medicine leaders who received the vaccine on December 16, the first day it was available.

Operating with Intention

While Polite was wrestling with her decision to get vaccinated, CMO Brennan was studying the dynamics within the Penn Medicine staff and considering the operational implications of a mass vaccination push.

What led to success was the one-two punch of an efficient operation that came to life mindful of issues of trust and emotion. So the rollout, for instance, ensured from day one that Penn Medicine staffers could see someone from their community who had opted to receive the shot.

The team recognized that no operational work could succeed without first addressing the concerns of the people involved. That concept is going to prove vital in future non-pandemic, non-crisis change management efforts. Whether getting employees vaccinated or getting them comfortable with a new strategic initiative, addressing the emotional weight of the situation must come early on. This is especially true for skeptical groups – in this case, people of color wary of vaccinations.

Here’s how it looked from Polite’s vantage point: “We’re asking you to not just trust science; we’re asking you to trust us. We did it. We’re not asking you to be blindly faithful. We’re letting you know that you can see us in action.” This idea of trust and honesty demonstrated through personal example was at the root of Polite’s ability to move the needle. She didn’t need to “convince” anyone so much as show them.

Backed by Numbers

Looking at the other side of the coin, no amount of emotional support can make up for a poorly executed plan. Weak operations can damage the most carefully cultivated trust. Feel-good stories open the door, but they don’t finish the job.

Brennan and his team turned to the numbers. They wanted to understand the nuances of vaccine acceptance across the Penn Medicine constellation with a particular eye toward job position and race. “In this context, occupation is a surrogate for zip code,” said Brennan, referencing the public health method of using residential zip code as an effective way to categorize peoples’ demographics like socioeconomic status and race/ethnicity.

“White employees had a higher vaccine acceptance rate from the get-go,” he said. Only about one in five Black employees scheduled a vaccine appointment in the first week, compared to more than half of white employees. Other groups fell somewhere in between.

Brennan and his team worked to close the gap. Polite saw her mission clearly. “I have the opportunity as the chief to make sure that we are an institution that practices what it preaches and takes care of our vulnerable neighbors in Philadelphia,” she said.

Launching the Program

Here, the emotional and operational stories of Polite and Brennan merge.

Their solution was Operation CAVEAT, a multimodal educational outreach approach about COVID-19 and the vaccine that Polite fully describes in a Los Angeles Times column she co-authored with Penn Medicine colleague Eugenia C. South, MD, MSPH.

“CAVEAT allowed us to say, ‘Here’s the organizational structure around which we can be in direct contact with the folks who need to see us,’” Polite recalled. She also connected with the CMO of the Hospital of the University of Pennsylvania (HUP) about the lower vaccine uptake in people of color.

That conversation led to an introduction to Aron Berman, who leads environmental services, food services, patient transport and materials management at HUP. “We talked very frankly about the racial dynamics of his team,” said Polite.

Berman said, “There was a very clear problem with high-stakes consequences. I was fortunate to be in a position to have this conversation” and to use his position of leadership to, “do the right thing for our Black and brown colleagues.”

Through that understanding of his team, Berman, like Polite, recognized and acknowledged that race was a significant factor in vaccine acceptance and confirmed that his team wanted to hear from Black physicians.

Matching Tactics to Needs

Having determined who employees wanted to hear from, the next step was how.

Many of the employees on the teams Berman led had limited access to Penn Medicine email. So, the system’s vaccine-related information wasn’t reaching them while false or negative information from external sources was.

The health system responded quickly with several primary tactics:

  • Individual paper “vaccine invitations” that hourly employees could take to the vaccine center and walk in – no appointment, no waiting, no worries about trying to stretch a lunch break long enough to get through the process.
  • A series of posters and one-pagers featuring Polite and other physicians with quotes about why they got vaccinated and facts from the CDC.
  • A set of vaccine-related screensavers featuring Black physicians initially located in break rooms and clock-in/out rooms but later deployed throughout the health system.
  • Inviting physicians – at least one of whom was Black – to join the daily group huddles environmental services, food services and similar teams were already having to listen and answer questions.
  • A town hall meeting, open to anyone in the University of Pennsylvania Health System, featuring a highly diverse group of speakers.

The result was a notable – though not immediate – increase in vaccine uptake among Black employees. While the 30 percent gap they initially had actually briefly widened to 40 percent as uptake among all groups grew, it then declined as the efforts among Black employees gained momentum. Moreover, it’s likely that the effort put forth by the leaders involved will have positive long-term ramifications thanks to trust gained during Operation CAVEAT and related initiatives.

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