Beyond the Byline: COVID-19 vaccine mandates test hospitals’ culture

Modern Healthcare Senior Hospital Operations Reporter Alex Kacik, Post-Acute Care and Staffing Reporter Ginger Christ, and News Enterprise Editor Jeffrey Young talk about COVID-19 vaccine mandates and staffing issues.

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Music Credit: Coffee by Cambo

Alex Kacik: Hello, and welcome to Modern Healthcare’s Beyond the Byline, where we offer behind the scenes look into our reporting. I’m Alex Kacik. I write about operations. Post-Acute and Staffing Reporter, Ginger Christ and News Enterprise Editor, Jeffrey Young, are joining me today to talk about COVID-19 vaccine mandates and staffing issues. Thanks for joining me, Ginger and Jeff.

Ginger Christ: Thanks so much for having us.

Jeffrey Young: Hi Alex.

Alex Kacik: Hey. So Ginger, let’s start with you. Let’s start with President Joe Biden’s federal vaccine requirements. So these require that all employers with more than 100 workers be vaccinated affecting about 80 million Americans, and there’s roughly 17 million workers at healthcare facilities that receive Medicare and Medicaid funding and will also have to be fully vaccinated. And I know you’ve talked to healthcare executives on both sides of the issue, some of which support mandates while there’s hold off as they struggle tofind, you know, help – the nurses, technicians and other staff amid the latest COVID spike. I know there’s some exemptions that come into play here, but in general, how did providers respond to the latest federal requirement?

Ginger Crist: So as far as healthcare providers go, you know, a lot of them were already imposing their own mandates before the federal mandate came through. So for a lot of them, it wasn’t a big change. And for some of the others that were even kind of against a federal mandate, it wasn’t necessarily that they were against vaccines or vaccinations. Their concern was mostly with staffing and, you know, if they would have enough people left to care for patients, because staffing has already been an issue throughout the pandemic, it was an issue before the pandemic. And so, you know, they just want to make sure that they are able to continue providing patient care.

Most facilities with vaccine mandates have had a high compliance already. We’ve seen that usually in the 90% of fully vaccinated employees. There have been a few examples where that hasn’t been. or where there has been some problems. You know there was a facility in rural New York that made a lot of headlines recently. They had to, you know, at least temporarily, stop delivering babies because like their maternity staff walked out over the vaccine mandate in New York, which went into effect a bit earlier than the others. So, you know, there are things like that. But mostly, there’s been pretty high compliance and, you know, hospitals and other healthcare providers have said, you know, the mandates help them provide the best care to patients.

Alex Kacik: Gotcha. So, Jeff, how did this issue become so politicized? I see some contributing factors here. You have a workforce that’s been distrustful, their bosses after they couldn’t provide enough masks and other PPE in the early stages of the pandemic. You have many who are overworked as they cover for those who got sick and are out. Then you have people of color who have historical reasons to not trust the establishment. And then you have this misinformation that’s seeping into all sectors of society. In your reporting, Jeff, you came out of this story, what a week ago or so, that looked at this at a broad scale. You know, what’d you find about the political dissension here?

Jeffrey Young: Well, I mean, it starts with the fact that, these healthcare workers, wherever they are, are just Americans like the rest of us and they have their own political views and their own communities and their own sources of information. So, like, you know, to the extent that everything is politicized right now, it leads through to that. And then you add to that, you know, what you talked about, which is, chronic workforce problems that nurses and other hospital workers have been complaining about for decades, you know, and the weaknesses you know, that people talked about in terms of the number of staff and supplies and scheduling and all that stuff, you know, obviously really coming to a head because of the high volume of patients and just the constant trauma that they’re enduring.

Bon Secours Mercy Health has announced a mandate and I believe they did so before Biden said that everyone had to do this. But I talked to their COO about a month before that. And what he said to me at the time was basically ‘our vaccination rates in our facilities mirror what we see in the communities they work at, right?’ So, like you know,and we all know looking at the numbers that, you know, you can break it down a number of ways. But counties that voted for Trump over Biden have lower vaccination rates. The people who work in hospitals and nursing homes and other facilities in those counties are from those places, they’re of those communities. So you’re going to have that kind of resistance, I think kind of naturally occur because of, you know, negative partisanship and misinformation. But I do want to highlight again what you were just talking about, which is that, you know, it’s not that all of these nurses and other hospital employees or healthcare workers who are resistant to the vaccine are all, you know, conspiracy theorists who like listen to Joe Rogan all the time.

You know, they’re frayed, they are just frayed, and like you said, they don’t trust the people they work for. And now those are the ones saying, “You have to get a shot or you’re fired.” So all these things combined together, and that’s where you end up with these pockets of resistance and how you see, and this is true, even in California, and they had their mandate deadline on Friday. Big hospitals in L.A. and San Francisco and San Diego are doing very well in terms of getting their people vaccinated. But there are places in rural California where they just can’t get it done, and they’re asking the state for an extension.

Alex Kacik: Got it. Yeah. Let’s stick with California for a second. You know, our fellow that works with us, Mari, had some reporting, looking at sharp healthcare down in San Diego and they reported that 92% of their workers had gotten at least one dose of a COVID vaccine and 4% received medical or religious exemptions. They placed 305 of its 18,000 employees on administrative leave, you know, until they do get a shot. Kaiser and Stanford too are also opting to give non-compliant employees an unpaid grace period. They have 30 days for the sharp employees to get vaccinated or they’ll lose their jobs.

Ginger, what are the implications here, from a staffing standpoint? Can you provide us kind of an overview of your reporting you’ve seen in the post-acute sector among skilled nursing facilities and their struggles to get the required help to fill that demand and, you know, folks are losing their jobs. What does that mean for employers who need more assistance?

Ginger Crist: Yeah, so particularly in long-term care, there’s been a staffing crisis for a while. These are typically low paid jobs that aren’t valued much in society, so it’s hard to recruit people for those positions anyway. So, you know, there’ve been a number of surveys that have come out from some of those associations that represent long-term care facilities like nursing homes and, you know, assisted living sites, and basically all of them are reporting, you know, workforce shortages. So what that means is that people cannot be accepted into those sites. It means, you know, that they have to deny care to people because they don’t have staff, and the same thing goes for hospitals, you know. When we talk about not having enough beds, you know, that’s really just not having enough staff to care for people in most cases. So, we’re really seeing some of these things kind of filtered down to actual patient care.

Jeffrey Young: I’m sorry, if you don’t mind, I’d just like to add something to that too, which is that, you know, when we talk about vaccination rates being low in certain areas that happened to be areas especially in rural locations where they’re already chronic staffing problems, right? It’s not just that they don’t have enough staff and that some staff are quitting because of the vaccine mandates, because they’re operating in communities where people aren’t getting vaccinated and they’re flooding the hospitals. So, you know, there’s a labor supply problem here, but there’s also over supply of sick people, and like that has nothing to do with whether the hospital requires vaccines.

Alex Kacik: Sure. And then you get into like an ethical decision too on folks who are, you know, unvaccinated, who are taking up, yu know, a lot of the intensive care resources. And I’m wondering, you know, when you talked with…Jeff, you mentioned Bon Secours Mercy. I know you talked with some of the first adopters among health systems of the vaccine mandates. How do they weigh, you know, some of those decisions when it comes to like patient safety and the personal rights of their workforce? And also like how do you prioritize care as well among those who are, you know, taking up beds and they may be unvaccinated, then you have to turn away some folks that they can’t treat. I’m curious how that all plays out.

Jeffrey Young: What’s interesting, you know, is that the places where care is being denied the most are these states where they’re doing like crisis triage basically because the numbers are so high. And again, that’s something that was not created by the vaccines or whatever the rules in the workplace, but by what’s happening in those areas. But yeah, so for the story that I wrote, I spoke to the CEO of Houston Methodist and they were the first health system to announce that they were going to do this. And also the Medical University of South Carolina and Anova Health System. And the themes were pretty consistent. And frankly, this is what I would expect any hospital executive to say, which is, you know, “Our first priority is to keep our patients and our employees safe.”

And, you know, this virus has killed thousands of healthcare workers. And that’s just the ones that we know about that are measured and recorded, you know. Not to mention the possibility of community spread from healthcare workers, although they are wearing a lot of equipment that most of us don’t have and that sort of thing. But, you know, this sort of underlying principle that people who don’t want to get vaccinated, or at least don’t want to be told they have to, you know, it’s bodily autonomy, right? ‘I don’t want to put a medicine in me because you told me I had to.’

But what all of these hospitals that did these mandates on their own, and I’m sure this is true with long-term care facilities and other healthcare, you know, settings where they put these rules in place before that government said they had to, is, you know, that concern is overwhelmed by the other priorities the hospital has in terms of, you know, patient and worker safety.

And, I mean, it makes sense as the CEO of Anova put it like, you know, “You look at the math, if you have a workforce that was 60-80% vaccinated in February, right, before anyone told them they had to, the people who work there basically voted for this mandate by getting their own shots, right?” And this is one of the reasons I did that story, too. Is that, you know, it tends to happen in our business that we pay attention to the loudest angriest people who are talking, but the people protesting these mandates and picketing their hospitals are a very small minority of the healthcare workforce. Now that doesn’t mean that if 10% of the healthcare workforce disappears in one day, it won’t be incredibly disruptive to operations. But nevertheless, you know, our perspective is a little skewed on this.

You know, nobody protests in favor of vaccine mandates, they just expect their employers to take care of them. Mark Boom, the CEO at Houston Methodist put it,you know, this is kind of a cliche, but he was like, “You have a right to swing your fist until it hits me in the face.” So, and that’s essentially, you know, that the analogy there is that if you’re working in a hospital and you’re leaving yourself exposed to COVID infection, you are potentially punching your patients and your co-workers in the face, and that, that’s not fair to the rest of the workforce. And of course, the people in the hospital coming in for care.

Alex Kacik: And Ginger, you’ve reported that workers who refuse to get the vaccine could be denied unemployment benefits. You know, how do, you know, what are the legal standards there and how do state unemployment laws come into play?

Ginger Crist: Generally, most states have similar language saying that if you’re laid off through no fault of your own, you’re guaranteed unemployment benefits. However, when it comes to these vaccine mandates, it typically would be an employee not following or not adhering to a company policy. So in that case, it is through their own fault that they are refusing to meet a company standard. So, there are obviously some exceptions, but in most cases it seems like they would not be covered. The legal experts that I spoke to said, “Basically, if a company has a policy and you don’t follow it, and it’s a fair and reasonable policy, then you can be denied unemployment benefits.”

Jeffrey Young: I mean, if you think about it, right, at will employment is the norm in this country. You know, you can be separated from your job for any reason at any time. And with something like this, it’s a workplace rule. And what’s interesting and I don’t know that this reflects anything other than this one particular health system, but the CEO of the Medical University of South Carolina told me when I interviewed him for that story, that the five employees who at the end were not in compliance by the deadline, one of whom by the way, changed their mind and came back, so they had lost four people.

But he told me that all four of those people were also in violation of other company policies. So this was like another, just the vaccine thing would have been enough, but I think what he was trying to get across with it, “maybe these employees weren’t the most committed to our workplace in the first place.” So yeah.

I will say though too that, and I forget where this is, but at least one state, the legislature is looking to require or to allow people to get unemployment benefits if they lose their jobs because they won’t get vaccinated. It was somewhere out West, I can’t remember where?

Ginger Crist: Jeff did bring up a point that I wanted, that I think is important to note too, in that one of the things that some healthcare executives need to do or have said is important is that when they’re talking about these vaccine mandates, is that they’re really talking to their workers and understanding what their hesitation is. And I think we alluded to this earlier, you know, but there’s a lot that goes into making the decision to get a vaccine. And often it doesn’t have anything to do with a vaccine. It could be not having trust in leadership or, you know, bad experiences that have happened in the workplace. And that seems to be the case in some of these people who are leaving, there’ve been other problems there. And so there’s this need also to look at what other issues are happening in a company so that you can address those, and then that can also help improve vaccination.

Alex Kacik: There’s a huge cultural component here, where if you didn’t have across your corporate structure, a good way of communicating to your employees, why something was happening, or if it was happening, then this really exposed some of those deficiencies.

So Jeff, you brought up an interesting point in your story too, where there’s a lot of discussion about how vaccine mandates may limit the pool of potential healthcare recruits, but potentially it could work in the favor of some healthcare facilities that have implemented, if, you know, those that at least greet agree with getting vaccinated is generally safer.

Jeffrey Young: Yeah. I couldn’t find anybody who had any numbers to back this up. And the hospitals that I spoke to basically were like, “Yeah, I can see that.” Well actually, no, one of them, I think it was the CEO of Anova, specifically said that he thinks this is going to be a recruitment advantage, particularly in a market like Northern Virginia, you know, where it’s very high vaccination rates of the workforce and the local communities where patients expect it, you know. Because part of my thinking about this story is like ‘if I were sick right now and I needed surgery, I wouldn’t want to go to a hospital where the workforce wasn’t vaccinated, I’m already sick, I don’t want to get sicker, you know.’ 

So far, no one is running ads or billboards or anything saying, “Come to our hospital because the other guys will give you a COVID,” but I feel like it’s only a matter of time.

But on top of that, yeah, there’s a lot of talk of course about people who are vaccine hesitant, you know, becoming travel nurses or going to states or facilities that don’t have mandates. And that surely is happening. Some portion of these people who are leaving their jobs are getting fired because they won’t get vaccinated or are being employed elsewhere in similar jobs. But from a recruitment standpoint, you know, if you think about how the vast majority of healthcare workers were vaccinated before anyone told them they had to be, if you’re looking for a new job and you’re among the vast majority of healthcare workers, it’s probably a question you’re going to ask. And an interesting thing too, that they told me, and again, I’ve seen this reported elsewhere, is that what they’re not seeing is new hires going, “Never mind, they don’t want the job now.”

And a lot of these places, when they rolled out the vaccine mandate in phases, the first phase was new hires. you know, so this is a condition of employment from day one, if you don’t like that, you don’t have to take the job. What people told me is that, that just hasn’t been an issue.

But again, this is not the downplay, the potential disruption that any individual facility losing 5-10% of its workforce, no matter what kind of workers we’re talking about, could have on a hospital. And again, given the regional variances, that does make it harder for those places to find new people who are already nearby.

Alex Kacik: Sure and any final thoughts, Ginger, on just the implications here. You know, we’ve seen the delta variant spread largely among the unvaccinated and many of those hospitalized, I think 98 some percent, according to Kaiser Family Foundation, you know, are unvaccinated and then are taking up acute hospital beds. But, you know, what are the implications here? People continue to hold out, both from public health and staffing standpoint.

Ginger Crist: There is an actual, real cost to people not getting vaccinated. Obviously we know about illness and we know that, you know, emerging variants will continue to spread, you know, as the coronavirus can continue finding new places to go. And so, you know, it will continue to evolve, we know that. But there is also a real financial cost, which, you know, is that Kaiser just recently did a report saying that the cost of unvaccinated people so far has bee five…Since vaccines were widely available has been $5 billion. And, you know, we’ve seen similar things like that at some of these facilities that – or companies that have imposed things like surcharges for employees on their insurance plans or things like that. Because they’re saying, “We see the data, we see that there’s a real cost for you being unvaccinated because it makes you more likely to get COVID-19. And so we need to make up for that cost in some way.” And it is putting a strain on, you know, the overall healthcare industry.

Alex Kacik: Ginger, thank you so much. Jeff, appreciate both of your expertise and time and helping us break this down.

Ginger Crist: Thank you.

Jeffrey Young: My pleasure.

Alex Kacik: All right. Thank you all for listening. If you’d like to subscribe and support our work, there’s a link in the show notes. You can subscribe to Beyond the Byline on Spotify or wherever you listen to your podcasts. You can stay connected with our work by following Ginger, Jeff and I at Modern Healthcare on Twitter and LinkedIn. We appreciate your support.