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Organizational Factors Associated with Successful Campaign to Increase Influenza Vaccination among VA Healthcare Providers

While previous studies have explored some of the organizational factors that may influence flu campaign performance in terms of achieving high vaccination rates among health care providers (HCP), much remains to be learned about this topic. Therefore, VA's Office of Public Health commissioned a study to characterize organizational factors and practices associated with vaccination campaign success among HCPs in the VA healthcare system. Investigators in this study used the "positive deviance method" to focus on six VAMCs during three consecutive fiscal years – 2011 through 2013. The Positive Deviance method identifies successful practices that already exist at sites with high performance (i.e., sites with extremely high HCP vaccination rates). Low performance sites (i.e., sites with extremely low vaccination rates) are included to provide contrast, and to help distinguish which practices differentiate between high- and low-performing sites. In this study, the three high-performing sites consistently had HCP vaccination rates greater than 70%, while the three low-performing sites consistently had vaccination rates below 40%. A total of 31 telephone interviews were conducted with key informants involved with HCP flu vaccination campaigns at these six sites.


  • Successful HCP flu campaigns shared several recognizable characteristics, many of which are amenable to adoption or emulation by programs hoping to improve their vaccination rates.
  • Three factors distinguished sites with high flu vaccination rates from those with low rates:
    • High levels of executive leadership involvement that demonstrated visible support, fostered new ideas, facilitated resources, and empowered flu team members.
    • Positive flu team characteristics, including: high levels of collaboration, sense of campaign ownership, sense of empowerment to meet challenges, and adequate time and staffing dedicated to the campaign.
    • Several concrete strong practices, such as: advance planning, easy access to the vaccine, ability to track employee vaccination status, use of innovative methods to educate staff, and use of audit and feedback to promote targeted efforts to reach unvaccinated employees.


  • These results can be used to inform efforts to create more effective HCP vaccination campaigns, and by extension help improve other safety initiatives that target HCP behavior.


  • Some aspects of organizational culture and operational realities present within the VA may not be fully duplicated elsewhere.
  • Limited funding precluded other qualitative study methods, such as face-to-face interviews and ethnographic observation that are commonly used in evaluating organizational characteristics.

Dr. Razouki is part of HSR&D's Center for Health Services Research in Primary Care (CHERP), Durham, NC, and Dr. McCullough is part of HSR&D's Center for Healthcare Organization and Implementation Research (CHOIR) in Bedford and Boston, MA.

PubMed Logo Razouki Z, Knighton T, Martinello R, Hirsch P, McPhaul K, Rose A, and McCullough M. Organizational Factors Associated with Health Care Provider (HCP) Influenza Campaigns in the Veterans Health Care System: A Qualitative Study. BMC Health Services Research. July 4, 2016;16(1):211.

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