As organizations consider mandating Covid-19 vaccinations for many of their employees, executives at Houston Methodist share the seven-step process they used to develop their own vaccination policy in a Harvard Business Review article.

On March 31, Houston Methodist became the first U.S. hospital to implement such a mandate, requiring that all 26,000 of their employees—with some exceptions—be vaccinated. The Houston Methodist executives sharing their insights included CEO Marc Boom; Susan Miller, chair of family medicine; Robert Phillips, EVP and chief physician executive; Roberta Schwartz, EVP and chief innovation officer; H. Dirk Sostman, EVP, chief academic officer, and chair of Houston Methodist's Vaccine Scientific Advisory Committee; and Carole Hackett, SVP and chief human resources officer.

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1. Create an ethical framework and hierarchy

To guide decision-making around a vaccination policy, Boom and his colleagues write that Houston Methodist first developed an ethical framework aimed at ensuring all actions were geared toward "doing good for the patient" and would not "harm the patient or others in society," among other key values. 

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The executives then applied these concepts to a "pyramid of responsibility," which consisted of patients and families at the top, followed by their employees, and then the Houston community. Based on this pyramid and their ethical framework, the executives concluded that once there was sufficient vaccine supply to ensure a vaccine mandate would not "create vaccine shortages for the community," such a vaccine mandate would help protect patients, staff, and the community at large.

2. Conduct a risk-benefit analysis

To make an informed decision about a potential policy, the executives write that Houston Methodist had subject-matter experts perform a risk-benefit analysis comparing vaccination and no vaccination. They asked, simply: "Do the available vaccines reduce the risk of harm from a Covid-19 infection more than they increase the risk of severe adverse reactions?"

Through the risk-benefit analysis, according to Boom and colleagues, Houston Methodist determined that based on the available research, vaccination was more beneficial than no vaccination.

The Pfizer-BioNTech, Moderna, and Johnson & Johnson vaccines have been found to effectively prevent infection and reduce hospitalization and mortality. In contrast, research indicates that nearly 4 four million people worldwide have died from Covid-19, with many of those who have survived the illness later presenting with ongoing health issues.

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In addition, vaccinating workers also decreases the risk of spreading the coronavirus to patients and other workers, which reduces the "social and economic harm" in a community, the executives write.

3. Establish legitimate religious and medical exemptions

According to Boom and colleagues, Houston Methodist ensured that its vaccination policy included accommodations for employees with medical conditions or religious beliefs that prevent vaccination. The organization granted deferrals for certain workers, including pregnant women. These exemptions comply with Texas law, which requires employers to provide exemptions for religious or medical reasons.

However, to ensure the safety of the larger hospital community, Boom and colleagues write that the organization tests workers who were granted exemption for Covid-19 every two weeks and requires them to wear protective gear, like face shields and face masks.

4. Offer valuable educational resources and messaging

Houston Methodist created a targeted messaging campaign, Boom and colleagues write, which used emails and open town halls to educate employees on the benefits of vaccination and the reasoning behind the vaccine mandate.

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According to Boom and colleagues, the campaign ensured employees were able to ask questions through a variety of platforms, including the town halls, email channels, and internet chat portals. The information on these platforms was available to workers across different levels of education, types of jobs, languages, and shift times, the executives write.

5. Push back against misinformation

In addition, Houston Methodist worked proactively to identify and correct any misinformation as it popped up. Executives also continued to share updated information about vaccination through emails and town halls.

6. Set an example for your workers

Managers and other executives at Houston Methodist set an example for their workers by requiring upper-level staff to be vaccinated approximately two months earlier than all other workers, Boom and colleagues write. This way, non-management staff were able to see their managers comply with the new policy.

7. Track vaccination rates and policy impact

Lastly, Houston Methodist monitored vaccination rates and shared how the policy affected workers to show employees that everyone was affected equally, and that the policy was an institutional priority. According to Boom and colleagues, research indicates that health care workers are more likely to get vaccinated voluntarily and follow vaccination policies when they know that others are complying with the policies.

According to Boom and colleagues, Houston Methodist's annual flu vaccine mandate reflects this success: That policy, implemented in 2009, followed these same seven steps and, for several years, and employee engagement scores for the flu vaccination policy have been above the 97th percentile.

While some may question whether a mandatory vaccination policy asks too much of employees, the main priority should be to keep employees, patients, and the community safe, Boom and colleagues write. "Organizations must strive to eliminate any avoidable harm, which clearly includes avoiding the transmission of infectious and deadly diseases." (Miller et al., Harvard Business Review, 7/1)