How to convince your health care colleagues to get vaccinated [PODCAST]

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“When a colleague in health care mentioned hesitation to get the COVID-19 vaccine in two separate instances, I was shocked and dismayed.

If we recommend vaccination to our patients, how can we not take the same precautions for ourselves?

With COVID-19 especially, anyone working in health care is exposed to many people and should be especially motivated to get vaccinated.

As cut-and-dry as this issue seems to me, I do remember similar issues with encouraging the flu vaccine and even mammograms among health care workers. We need to remember what worked in those instances and use the same tactics to improve vaccination rates among our colleagues.”

Dava Gerald is a physician surveyor, The Joint Commission.

She shares her story and discusses her KevinMD article, “4 steps to convincing health care colleagues to get vaccinated.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have Dava Gerald. She is a surgeon, and she is a surveyor for The Joint Commission. She wrote the KevinMD article “4 steps to convincing health care colleagues to get vaccinated.” Dava, welcome to the show.

Dava Gerald: Well, thank you very much. I appreciate that.

Kevin Pho: So we’ll get into the article in a little bit, but first off, can you share your story and journey to where you are today?

Dava Gerald: Well, I started out actually wanting to be a surgeon, and I didn’t find out I had to be a physician first until I was in high school, and that added another eight years or so to my life. I became a surgeon at a time when I was the first woman surgeon in my training program. I practiced in South Orange County and had a very unexpected leadership experience in the 1980s or so, which led me to really a passion for physician leadership. That ultimately culminated in me becoming very active when the breast cancer world was just beginning to wake up, and I took a prominent role in that, which then led me into leading cancer programs, both academic and community, and doing an executive MPH at UCLA.

That led me into surveying for the American College of Surgeons Commission on Cancer and the National Accreditation Program for Breast Centers. As I did that and went around the United States surveying both large and small programs, it became very apparent to me what a major role safety in health care was providing. That allowed me to transition to The Joint Commission, where I’ve been for the last year and a half, and it’s been a whirlwind ride learning about the complexity of health care and the devil in the details, and merging that with my physician leadership passion. So it’s very exciting to me.

When I was first surveying, in my very early survey days, we were a number of surveyors, probably five or six of us, in a room, including our life safety engineer, and we were fed up with wearing masks. So I said, “OK, everybody’s vaccinated in this room, right?” And the life safety engineer said, “No, I’m not vaccinated.” It frankly shocked me. This was a life safety here, but I was also curious: “So why did you, in fact, not get vaccinated?” This was probably May or so, when those in health care, and we were in hospitals every week, hadn’t gotten vaccinated. He said, “Well, I really haven’t had time to look at the pros and cons of vaccination.” And he was a person with some comorbidities, so we had a chat about that.

But it led me to think about, in health care, are there other physicians? And then, of course, we saw there are some politician physicians who are not surveyed and are very vocal about that. What could we do as physicians? It’s not just the scalpel we use or the laparoscope or the prescription pad or the orders we write to influence health care for our patients and for each other. So that’s kind of my story of how I came to write this article and to think about this problem, which is not that different, if you think about it, from how we first encouraged women to get screening mammograms. That was a very similar challenge that we faced early on and continue, to some extent, to face.

Kevin Pho: So let’s jump into that article. You wrote it back in May, like you said. It’s titled “4 steps to convincing health care colleagues to get vaccinated.” And as you said, health care workers getting vaccinated continues to be an issue, now that we’re speaking toward the end of July. In fact, I’m looking at today’s New York Times, and the title of this headline is “More hospitals are requiring workers to get COVID vaccines,” because some health care workers are still refusing to be immunized. Now, for those who didn’t get a chance to read your article, can you just walk my audience through it and, of course, share the story of why you decided to write it?

Dava Gerald: As I looked at it and reflected on my experience with screening mammography, the first thing we really needed to do, rather than just telling people to get a mammogram or sharing numbers, was to understand what was preventing them. Through talking with them at that time, we came up with a whole host of what we call myths, which were actually kind of interesting, and some of them were culturally specific or age-specific, and we could generalize from that.

So my thought was, first, to talk with our colleagues to understand why. First, to understand, rather than jumping in and saying, “OK, you really do need to get vaccinated,” or throwing numbers at them. To really meet them where they were, which is a guideline for so many other things that we do in life, and what is really holding them back, and then to discuss that. So first, I looked at doing a qualitative study, really based upon, what are the factors holding you back from getting vaccinated? So that then, we could talk about the pros and cons in a way that was meaningful to them.

Then the next step, as I thought about it, was that physicians, as well as many other health care workers, are really time-starved in terms of education or learning, other than maybe flipping on the TV. How can we create specific messages that address the most common reasons why health care workers or physicians are not getting vaccinated? And how can we do that in a way that is easy and convenient and in many locations?

And then, I’ve always had the belief, especially for physicians, that you want to combine the numbers with the story. I think all of us have some sort of story related to COVID, even if it’s, “I don’t like wearing a mask,” to the other end of the spectrum, where, “I lost my parents to COVID,” and having them talk about that. So, educational modules that combine both. That qualitative sense: The stories stay in people’s minds, unquestionably. That’s what our brain is triggered for. The numbers will take care of our scientific side of our brain, which will help bolster that.

The other thought I had, and I’m smiling now because I remembered doing this when I was collecting Red Cross money in the sixth grade. I was the Red Cross monitor, and I would put on the blackboard everybody that had contributed, and that was a response. What I really wanted to do was put the names of everybody who hadn’t contributed, but I recognized the power of peer pressure. Certainly, in organizations that are departmental, you can create a friendly competition. It is, in many of the health care environments where you have formal departments of medicine, pediatrics, surgery, whatever: What’s the first group that makes it to 100 percent? Where are the other ones? And even putting up de-identified numbers, how many we are still requiring, to put a little peer pressure on the area.

And then, to have some reward for becoming vaccinated beyond the obvious long-term reward of, you’re highly unlikely to die from COVID and unlikely to even experience COVID. That’s especially now, with the Delta variant being so transmissible. Is it back in play again? So, the more lenient rules for those who are vaccinated.

And I would say that I’m in the ballpark of mandatory vaccination. I mean, when I think about it, what things should be for freedom, and you should be very liberal, and what things should be rule-based? For example, we all need a driver’s license to drive a car. If you’re not trained and you can’t perform well, you’re a danger. You’re even a danger sometimes when you have a license. But nobody disputes that you should have a license. So to me, it’s very odd that we should now have such a debate about having our liberties taken away from us by being required to be vaccinated, whether it’s working in health care or kids going to school, which is another topic that’s in the news quite a bit recently. It seems to me there are certain circumstances, when you are putting other people at risk, where the societal need takes precedence. That’s my own personal feeling about this.

But certainly, the physician should be in the lead role. That separation of public health from clinical care is not in either discipline’s best interest. We do know, for example, that in the 20th century, the major opportunities that we took to advance life expectancy really were in the public health field. They were having sewerage, having clean water, and then later, the vaccinations that were available. They weren’t in any particular drug that we dispensed. So public health should be more robustly presented, I think, within the curriculum of physicians or other health care providers.

Kevin Pho: One of the most powerful points that resonated with me is understanding and empathizing with the motivations of those who are hesitant or refuse vaccines. Now, when you ask care workers about some of these motivations, what are some examples of answers that you receive?

Dava Gerald: It’s usually, “I’m too busy,” or it is, “Well, long term, there might be some effects we don’t know about yet.” These vague answers give me the gut-level feeling that maybe it’s more politics than it is actually science. And I remind folks that what we do is evidence-based. It’s science. We’ve bought into that as a profession. We believe that, and to kind of make this exception, there’s a dissonance with that. So, “I want others to get vaccinated, but not me or not my family,” or, “The other people get the disease,” or, “I’m not old,” that initial thought, “Well, I’m healthy.”

We still hear that in breast cancer: “Well, I’m very healthy. Nobody in my family had breast cancer, so I’m not going to get it.” Well, in the breast cancer world, only 10 to 15 percent of breast cancers are inherited. Yes, I often hear, “Well, I’m really very healthy.” Well, we know very healthy people have also died from COVID, and that very healthy people have often transmitted it to their families, their friends, etc.

But those are the most common comments I have. It’s challenging, at least for me, to be able to ask that question empathetically rather than to point a finger and say, “You’re a bad person.” So I really work on my head first when I ask that question, to understand that these folks have a belief, and to maybe show them where their belief is dissonant with some of their other beliefs. I found that to be helpful.

Kevin Pho: Now, as you mentioned, and as we both know, we live in a very polarized society, where it’s very difficult to change one’s mind, especially since the vaccine has been politicized. Now, short of mandating the vaccine, do you expect us to move the needle using some of these efforts?

Dava Gerald: I think if it was work-related and mandated, there’s the opportunity. But a general, wide mandate, I think we’re past that stage of being able to have done that. I think early on, given a different political situation, that would have been possible.

Kevin Pho: Do you expect these tactics to realistically move the needle and convince health care workers to receive the vaccine?

Dava Gerald: I can remember, for example, I was working in Memphis, in Tennessee, in a community that is tobacco-related, and all of the hospitals got together and said, “Together, we’re all going to determine that we’re going to be non-smoking,” because we knew if it was one or the other, the patient would just go to the other hospital. So I think this is not, in some ways, unlike that, where if all the hospitals together decided, “This is what we would expect,” there’s the opportunity to do that.

Do I think it’s going to happen? I don’t think so if we get to be too, I’ll use the word, “nice” about it. That lets folks off the hook. Folks who are sharing the disease with other people, it lets them off the hook. But to bring to their attention they wouldn’t really want to be responsible for someone else getting it. That, I’m sure of. And to relieve some of their concerns. But hearing, “Well, it’s just an emergency authorization,” again, I felt that from a physician’s standpoint, a scientist’s standpoint, we understand what that really means, and the data that’s already there.

Kevin Pho: We’re talking to Dava Gerald. She’s a surgeon, and she’s a physician surveyor for The Joint Commission. She wrote the KevinMD article “4 steps to convincing health care colleagues to get vaccinated.” Dava, I want to switch to another topic. A lot of people have preconceived notions about The Joint Commission, so you have a platform here. What is the biggest misconception of The Joint Commission, and what can you do to dispel that myth?

Dava Gerald: OK, I think the biggest misconception is that we’re the bad guys, that we’re there to castigate organizations. There was a very deep change in the culture when it went from JCAHO to The Joint Commission. We are collaborative. All of the clinical surveyors have had significant clinical experience. They’ve also had leadership experience, and we want to educate, and we want to collaborate.

And what we bring, I look at it as, it’s like a treasure hunt for us, where if we can find something that can be corrected before someone is hurt by that, it’s really like a gift, which is what I used to tell folks when I was leading an organization. But we’re collaborative and educational, and we’ve all been on the other side. And we enjoy what we do. We know how important it is, and we work hard to help folks relax when they talk with us.

Kevin Pho: And my final question: What’s your take-home message that you want to leave with the KevinMD audience?

Dava Gerald: My take-home message really is, those of us in health care really need to be an example to the rest of the community, and that we have a responsibility to do that.

Kevin Pho: Dava, thank you so much for sharing your time and insight, and thanks again for being on the show.

Dava Gerald: Sure, thank you very much.

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