Information for Pilot Sites


Recording of the live training for pilot sites conducted on 07/13/2022

AMDA Interventions

Description of potential interventions that pilot sites can select.

QI Basics

Review of the Plan, Do, Study, Act (PDSA) model used in quality improvement projects.

Data Elements

Overview of process for data collection for the project, including an example of how to calculate numerators and denominators.

Group Call Speakers

Barbara Resnick, PhD, CRNP

July 2022

  • Be or identify a champion – a champion is a clinical staff member who leads efforts to advance immunization practices, rates, reporting, and quality within a clinical practice.
  • Gather a team – should be 3 to 4 people and can include office staff, director of nursing; assistant living manager or resident coordinator, etc.
  • Establish the barriers/challenges – these are different in each facility and could involve staffing challenges, financial barriers, a need for education or materials, etc. Don’t assume you know what they are – ask front line staff, residents, etc. for their thoughts.
  • Establish solutions – solutions also vary by facility; select solutions that are implementable for your team. No single solution will fix everything, but you should start to see progress.
  • Make it happen – follow the NVAC Standards
    • Assess patients upon admission and yearly thereafter
    • Give a strong recommendation for vaccination
    • Administer the vaccine
    • Document and report the vaccine

JoAnne Reifsnyder PhD, MSN, MBA, RN, FAAN

August 2022

  • To effectively change human behavior, we need to understand the person’s unique circumstances and intervene with compassion. Education alone is not usually enough to change complex human behavior.
  • When talking to staff, use stories over statistics and immediate over long-term benefits. Frame discussions in terms of protection from loss. Use social networks and trusted advisors. Make the right thing to do the easy thing to do. Seek commitment and avoid an avalanche of information.
  • For example:
    • Provide pat on the back to reinstill pride – leadership acknowledges individual efforts in public forums (eg, spoken in huddles, written on white boards); peers schedule gratitude moments in daily huddles for peers to celebrate one another; residents are empowered along with families to offer thanks with gratitude certificates. These are carrots that add positivity to counterbalance sticks and break up the mundane nature of adherence.
    • Create a sense of team: create cross-departmental contests (eg, t-shirt design) for localized swag and generate amity with unique activity (eg, staff-nominated song of the week handwashing lyrics). Generate cooperation from celebrated tier-based status such as QAPI audits and display success notably in-center.
    • Provide small tokens to celebrate wins – surprise and delight with unexpected offerings. Use variable reinforcement, such as align QAPI audits with unpredictable seasonalized rewards (eg, state fair food truck, Halloween candy provisions, Thanksgiving turkeys).
  • Consider wall signage – a place for people to post pictures or thoughts completing the phrase, “We vaccinate for…”

Leslie Eber, MD, CMD

September 2022

  • Personal stories are important – people are still dying from COVID and those are someone’s mother, father, or friend.
  • Don’t start the conversation with hesitant staff with vaccines. Ask what people want to know about COVID – are we in an endemic state? How will it interact with flu? Isn’t the new strain less serious?
  • Use a new voice to talk about COVID in your facility. It’s easier to tune out voices that have been talking about COVID for a long time.
  • People want to hear that they are seen, heard, and respected. Building trust is key. AHCA has a new toolkit to assist with building trust.
  • You don’t have to “seal the deal” in one conversation.
  • Activate people’s agency when talking about the vaccine. They have a choice and power.
  • Incentives can be effective but they have to make sense – PTO for vaccine side effects, for example.

Alice Bonner, PhD, RN

October 2022

  • Cycles of change take time. But faster testing leads to faster learning.
    • Start with one older adult; one event; one nurse; try it ONCE!
    • Test small, test often – use a daily review (huddles), a weekly plan, and 90-day goals
    • Increase scale of tests as process redesign matures
  • Work towards moving from a standpoint of compliance to one of commitment.
    • Instead of stating a minimum performance standard that everyone must achieve, consider stating a collective goal that everyone can aspire to.
    • Instead of using hierarchy, systems, and standard procedures for control and coordination, consider stating shared goals, values, and a sense of purpose.
    • Instead of the threat of penalties, sanctions, or shame for delivery of messages, state a commitment to a common purpose that creates energy for delivery of messages.
    • Instead of stating goals based on organizational commitment (“If I don’t deliver this, I fail to meet my performance objectives”), consider stating goals based on a relational commitment (“If I don’t deliver on this I let down you/the group/our shared purpose”).
  • Use public narrative as a leadership practice to motivate others to join us in action.

Swati Guar, MD

November 2022

  • With rising incidence of influenza and COVID-19 this season, staff need to know that they can make a difference by getting vaccinated. Use data to show the peaks in incidence, how the vaccine helps reduce illness, and effectiveness of the bivalent vaccine in terms all staff will understand (eg, people 55 years and older have a 13.2 fold rise in protection from pre-bivalent vaccine levels).
  • Staff do not have time for 1 hour webinars. Consider 5 minute videos, a public leadership commitment, competition (who can get vaccinated first?), continuous interval town hall sessions to become a trusted source of information, 1-on-1 sidebar conversations and hallway troubleshooting, and creating peer group leaders.
  • Create a clear pathway from information to immunization.

Sheena Bumpas, CNA

November 2022

  • Frontline staff need to be on the same page as facility leadership. Be transparent about efforts and regularly show the impact of their efforts with data.
  • When talking to staff about vaccinating themselves, be upfront about the side effects and why they are worth it.
  • Make vaccination easy and help frontline staff feel included in the efforts.
  • Celebrate the goal.