Will carrots or sticks raise influenza immunization rates of health care personnel?

New Joint Commission on the Accreditation of Healthcare Organizations standards require health care organizations to implement staff influenza immunization programs and track employee immunization rates. Although the Centers for Disease Control and Prevention have recommended influenza immunizations for health care workers since 1981, employee vaccination rates have stagnated at 30% to 40% for several years. With the recent attention on these low rates, some institutions have increased employee rates significantly with robust, multifaceted immunization programs. Others have attempted to require immunizations as a condition of employment. Declinations signed by those who refuse immunizations also have been proposed. This article examines recommendations for employee influenza immunizations and the evidence for effective strategies that increase coverage rates. With so much misunderstanding about the influenza immunization, robust interactive education, and onsite, easily accessible vaccination at no cost to employees--the carrots--may be more successful in increasing rates than are declinations and work exclusion--the sticks. Strong immunization programs may create the tipping point for making influenza immunizations as routine in health care as gloves. More robust staff immunization programs, evaluations of their effectiveness, surveillance of health care employee immunization rates, as well as further evidence of effectiveness of declinations and work exclusions should guide further policy formation and implementation.

Managed care and patient safety: risks and opportunities.

OBJECTIVE: Patient safety practices have primarily focused on providers, such as hospitals and ambulatory or long-term care. Based on the premise that most medical errors and patient safety problems arise from system issues, and that managed care constitutes the largest, most integrated system in health care, the authors examine the role of managed care in making patient care safer. STUDY DESIGN: Review of the literature and analysis of the role of managed care in patient safety. RESULTS: Authors find that although much has been written regarding managed care and quality, there is little research on managed care's relationship to patient safety. Research shows that managed care is not significantly different from indemnity insurance in terms of quality of care. However, managed care contracting, reimbursement, and management practices result in health care utilization changes that could pose potential risks for patient safety. Although managed care may pose possible risks to patient safety, practices can be monitored and adjusted to maintain quality and safety. At the same time, managed care provides opportunities for promoting patient safety at an integrated system level. Managed care organizations are in a unique position to influence patient safety by using safety strategies in selective contracting, financial incentives for performance, quality improvement programs, consumer education, and management and integration of care delivery. Our literature review reveals that health plans are starting to implement some of these strategies, but the practice is not widespread. CONCLUSIONS: Authors conclude with a framework and recommendations for patient safety.