Houston Methodist CEO, execs: How to develop a vaccine mandate

On March 31, Houston Methodist made the decision to mandate COVID-19 vaccines for all 26,000 employees at eight hospitals. Six health system executives, including CEO Marc Bloom, MD, shared seven ways to develop a COVID-19 vaccine mandate in a July 1 Harvard Business Review report.

Before the mandate, vaccination rates stagnated at about 84 percent. After the mandate took effect June 7, about 98 percent of the health system's staff had received the vaccine, with 2 percent of staff receiving exemptions or deferrals.

Here are seven steps to developing a vaccine mandate:

1. Establish an ethical hierarchy.
   The health system developed a pyramid of ethical framework and responsibility, placing patients at the top, Houston community members in the middle and hospital staff at the bottom. They considered how a vaccine mandate would affect vaccine supply in the community and patient safety.
   
   
2. Conduct a risk-benefit analysis.
   The analysis needs to be performed by subject-matter experts and must examine if the risk of COVID-19 infection is worse than the risk of adverse vaccine reactions.
   
   
3. Ensure religious and medical exemptions are consistent with local laws.
   In Texas, employers are required to grant exemptions on religious and medical grounds. For employees with permanent or temporary exemptions, they will be tested for COVID-19 biweekly, wear a face shield and a face mask.
   
   
4. Provide an educational campaign.
   Educate team members on the risks and benefits of getting the vaccine versus not getting the vaccine. Houston Methodist provided open town halls with subject-matter experts and sent out email campaigns with information.
   
   
5. Combat misinformation.
   The health system worked throughout the pandemic to fact-check misinformation in town halls and emails. Employee feedback showed that employees appreciated transparent communication.
   
   
6. Require management to get the vaccine first.
   Before asking hospital employees to comply with the mandate, the health system put out a policy requiring managers to get the vaccine first. There was a two-month gap between the deadline for managers and all other hospital staff.
   
   
7. Monitor results.
   The health system launched a flu vaccine mandate in 2009, with which 97 percent of employees have complied since its original launch. Monitoring results can keep the number of vaccinated staff members at the desired percentile.