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Supporting an equitable vaccine rollout: Building staff vaccine confidence

Over the course of the COVID pandemic, CQuIPS members and alumni have stepped up in significant ways to support their colleagues, patients and communities. In this special series, we highlight the work they’ve done towards a more equitable recovery.

Dr. Adina Weinerman

When Sunnybrook began planning vaccine rollout to staff, Dr. Adina Weinerman, Medical Director of Quality and Patient Safety at Sunnybrook and CQuIPS Certificate Course Co-Director, immediately thought about staff who would be hesitant.

“From everything I had been reading and our data from previous flu vaccine campaigns, I knew there would be staff who would not be interested in getting vaccinated – even those at very high risk based on where they live, how they get to work or their specific job,” she said. “Senior leadership was appropriately focused on the logistics of efficiently getting people vaccinated who immediately wanted the vaccine so Brigette Hales and I decided to work on a strategy for those who might need more information or time to understand the benefits.”

Working with Hales, Director of Quality and Patient Safety at Sunnybrook, Weinerman ran a mutli-pronged campaign that included recruiting more than 70 peer champions who could answer questions for their colleagues, creating frequently asked questions informed by qualitative interviews on hesitations identified by staff, and leading small group huddles in areas where vaccine uptake was low. They also partnered with the President’s Anti-Racism Task Force (PART) at Sunnybrook to inform a virtual session specifically for Black staff on the impact of COVID and vaccination.

“We knew objectively that COVID disproportionately affected Black communities in Toronto and Ontario and there’s a history of racism in vaccine creation and rollout,” she said, “so there was a real reason we thought it was important to reach out. It wasn’t that we anticipated more hesitancy than in other staff, but we knew there might be unique concerns and considerations. PART led the forum with an all-Black staff panel which included physicians, nurses and health professionals.”

Above and beyond all of that, Weinerman and Hales created an email address where staff could send their individual questions related to COVID – and the two personally responded to hundreds of emails.

“We really tried to take an approach where we understood that for many people, this is layered and deep and they have a lot of personal conflict related to vaccines. There was a ton of information everywhere but also a lot of false information so we wanted to be a source of impartial, truthful information so that people could make the best decision for themselves,” she said. “All along, people had great questions – it was clear they were reading about it on their own. It was completely worth it.”

As a result of their efforts, Sunnybrook reached an over 80 per cent staff vaccination rate in the spring – higher than the 70 per cent seen most years for flu vaccine.

Dr. Alena Hung was one of the staff champions recruited by Jennifer Wong. Her sign here reads: Have you received your COVID vaccine?? Questions????

Jennifer Wong deserves credit for that number too. A speech-language pathologist (SLP) at Sunnybrook and CQuIPS Improvement Fellow, she took on the task of leading staff vaccination confidence efforts in the Veterans Centre where she’s worked for more than a decade, home to some of the hospital’s most vulnerable patients.

“That’s our division of long-term and palliative care,” she said. “We’ve certainly seen in the news the impact COVID has had in this sector over the pandemic, so that was an area we really wanted to target, knowing the high risk.”

With the vast majority of residents getting vaccinated early in 2021, Wong turned to staff. Working with patient care managers and using her own knowledge of the centre, she recruited staff champions, bringing them together for weekly huddles to share latest updates, dispel any circulating myths and collaborate on strategies for challenging conversations. Champions were encouraged to recruit others as well so there was a network of respected individuals who could support their colleagues.

“We know from the literature that in terms of battling vaccine hesitancy and building vaccine confidence, being able to talk to someone who’s trusted and has a personal and vested interest in you is impactful,” she said. “And then everything we did after that was based on feedback we were getting from champions – we really tried to be responsive to what we were hearing from the front line.”

Other strategies included making it easier for people to book vaccines, as many staff don’t regularly check email; Wong and her team set up a booking table in the lobby and registered people on the spot in their areas. They also regularly visited units that needed additional support for walk-throughs or huddles to answer questions.

“Within the Veteran’s Centre, there are 15 patient care units and close to 500 beds so the staffing is massive,” she said. “We knew our small army couldn’t tackle everywhere so we used a data-driven approach to find out which areas needed the most attention and focus.”

Always focused on quality improvement, the next steps for Wong include collecting qualitative data on the efforts, identifying what enabled champions to be effective and what further barriers they encountered so they can be prepared for the next vaccine campaign.

“One of the main things I’ve drawn from this is that it’s important to understand how people are connected to each other and relate to each other,” she said. “It’s been a really great opportunity to use both QI and soft skills; that’s always been something that’s really interested me – it’s one thing to engage stakeholders, it’s another to create behaviour change. And it might just be my SLP background, but it’s important to recognize that how you say things is equally as important as what you say.”

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