Little progress has been made in recent years to improve flu shot uptake, but new research suggests spurring competition among providers to get more patients vaccinated could be the key to turning the needle, RJ Niewoehner and Bradley Staats write for Harvard Business Review.

How any organization can achieve universal employee flu vaccination

Niewoehner is a doctoral candidate in operations at the University of North Carolina's Kenan-Flagler Business School, where Staats is a professor of operations.

What incentives motivate providers to achieve higher vaccination rates?

Since 2010, the share of Americans who get a flu shot hasn't cracked 50%—and in 2017 the share dipped to a low of 37%, Niewoehner and Staats write.

Typically, interventions to encourage the flu shot is geared toward patients, but providers have significant influence over patient behavior, Niewoehner and Staats write, noting that one study found that 99% of patients accept a flu shot when their doctor recommends it.

To figure out the best method to motivate providers to wield this influence when it comes to flu shots, Niewoehner and Staats partnered with technology company VaxCare to conduct a randomized control study. The study took place in 145 health care clinics across nine states from August 2018 to December 2018.

The researchers randomly assigned the clinics to one of three groups and assessed them based on the number of vaccinated patients. The researchers motivated the clinics in the first group through financial incentives, such as financial bonuses for year-to-year growth in the number vaccinations as well as additional money for meeting their vaccination target.

The researchers used competition to motivate the clinics in the second group by notifying them of how their vaccination rates compared to other clinics. The third group was the control group and received neither financial nor competitive motivation to meet their vaccination targets.

The researchers found the number of shots administered by clinics motivated by competition grew by 10%, while the number of shots administered by clinics that received financial incentives increased by less than 1%. Meanwhile, the number of flu shots administered by the first two groups increased by about 6% more on average when compared to the control group.

4 ways to improve vaccination rates through providers

Based on their research, Niewoehner and Staats identified four ways health systems can improve vaccination rates through their providers:  

1. Financial incentives are not effective in every context. "In today's busy world, our attention is often our scarcest resource, and money isn't always the most effective way to focus our attention on achieving particular goals," Niewoehner and Staats write.

2. The saying, 'What gets measured gets managed' is true here. While the United States has made little progress in improving the national vaccination rate by focusing on patients, the researchers' study shows that measuring providers' performance relative to their peers is effective in increasing vaccination compliance rates. "In other words, make it personal," they write.

3. Be careful of how you share feedback. "When choosing how to provide feedback, leaders should carefully consider the organizational dynamics and the best way to achieve the desired outcomes," Niewoehner and Staats write. For instance, public feedback is great for sharing best practices and praising high performing providers, but on the other hand publicizing critical feedback can "embarrass[s] individuals, causing people to resist participating in the initiative," they write. In situations like these, "private feedback could be the way to go."

4. Consider which stakeholder should be the focus. While most attempts to improve vaccination rates focus on patients, Niewoehner and Staats' study demonstrates that provider-focused intervention held untapped potential. The write, "the best way to achieve a desired outcome may be to focus on one group, not another, or it might be to focus on both" (Niewoehner/Staats, Harvard Business Review, 11/5).