Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK.
Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK.
Vaccine. 2020 Mar 30;38(15):3079-3085. doi: 10.1016/j.vaccine.2020.02.077. Epub 2020 Mar 5.
Health care workers are a priority group for seasonal influenza vaccination, which is recommended by the World Health Organisation. There is a wide variation in uptake between and within countries. England has achieved 69.5% of health care workers vaccinated overall in 2017/18 across NHS acute and community health care settings, but it varies between Trusts from 50% to over 92.3%. While attitudinal factors have been well researched, there is limited evidence on organisational factors associated with high uptake. In England, most NHS Trusts are now implementing a similar range of interventions as part of their flu programme, and it remains unclear why performance remains so variable. This qualitative study is the first to explore reasons for this variation and provide recommendations for lower performing Trusts on how to improve. Fifty-seven interviews of managers and vaccinators were conducted in nine hospitals with flu vaccination uptake ranging from just over 55% to above 90%. Our study found that while Trusts deployed a wide range of both demand generating and supply interventions to increase uptake, there were marked differences in the organisational and delivery models utilised. Our study suggests that organisational culture was possibly the most important ingredient when trying to differentiate between high and low performing Trusts. We found that a positive culture aimed at fostering continuous improvement and favouring non-coercion on balance yielded more adherence from staff. Where influenza vaccination was embedded in the organisation wellbeing strategy, rather than executed as a siloed seasonal programme, this tended to foster good performance. Improving performance of influenza vaccination in health care workers will involve not only deploying the right interventions, and following "best practices". It will require the adaptation of flu progamme delivery strategies to the organisation context, and embedding vaccination into the organisational culture, thus supporting the normalisation of yearly vaccination.
医护人员是季节性流感疫苗接种的优先群体，这也是世界卫生组织所推荐的。各国之间和各国国内的接种率存在很大差异。在 2017/18 年度，英格兰 NHS 急症和社区医疗保健机构内的医护人员总体疫苗接种率达到了 69.5%，但不同信托机构的接种率差异很大，从 50%到超过 92.3%不等。虽然人们对态度因素进行了广泛研究，但与高接种率相关的组织因素的证据有限。在英格兰，大多数 NHS 信托机构现在都在实施类似范围的干预措施，作为其流感计划的一部分，而为什么表现仍然如此多变仍不清楚。这项定性研究是首次探索这种差异的原因，并为表现不佳的信托机构提供如何改进的建议。在九家医院进行了 57 次经理和疫苗接种者的访谈，这些医院的流感疫苗接种率从略高于 55%到 90%以上不等。我们的研究发现，虽然信托机构广泛部署了需求产生和供应干预措施来提高接种率，但所使用的组织和交付模式存在明显差异。我们的研究表明，当试图区分高绩效和低绩效信托机构时，组织文化可能是最重要的因素。我们发现，一种旨在培养持续改进和平衡非强制的积极文化更能得到员工的认可。当流感疫苗接种纳入组织健康战略，而不是作为一个孤立的季节性项目来执行时，这往往会促进良好的表现。提高医护人员流感疫苗接种的绩效不仅需要部署正确的干预措施，并遵循“最佳实践”。它还需要根据组织背景调整流感计划的实施策略，并将疫苗接种纳入组织文化，从而支持每年接种疫苗的常态化。
