1 city, different paths: How Cleveland health systems approached vaccination mandates

When Cleveland-based MetroHealth System announced its COVID-19 vaccination policy last summer, at the core of the decision was the health system's mission, according to Akram Boutros, MD, president and CEO of MetroHealth.

"Our mission is about keeping every individual healthy and improving the health of the community. With that in mind, we thought: How can we help our patients be healthier and ensure safe care for them and improve the health of our community?" Dr. Boutros told Becker's. "It was very clear to us that being vaccinated would do that."

MetroHealth, Summa Health, Cleveland Clinic and University Hospitals, all based in the Cleveland metropolitan area, have taken varying approaches with vaccination policies. While some announced a mandate over the summer, others revealed in November plans to comply with federal vaccination rules. Here, Becker's takes a closer look at mandates at Cleveland health systems.

Mandate announced over the summer

MetroHealth, which has nearly 7,800 employees, announced its mandate Aug. 26 requiring employees to be fully vaccinated or receive a deferment or exemption by Oct. 30.

Dr. Boutros said he was optimistic in implementing the mandate given the health system's strong history of having employees be vaccinated against the flu (only 11 people received flu vaccination exemptions last year).

Since the mandate was announced, he has had open communication with employees about vaccines, and they often have emailed him directly.

"I would say there were about five individuals who were upset about it and directly contacted me," said Dr. Boutros. "Maybe another 50 or 60 asked questions we needed to clarify and explain some more to them exactly why we're doing it, how we're doing it."

As of Nov. 22, MetroHealth had terminated or dismissed four employees for refusing to comply with the health system's policy. Thirteen employees had decided to retire or leave the organization as of that date. Of the 13, nine were going to retire within six months and accelerated their retirement.

Additionally, 426 people applied for exemptions or deferments, and those who are receiving deferments include those who are pregnant or breastfeeding, Dr. Boutros said.

Overall, a majority of employees were fully vaccinated or would soon be fully vaccinated as of Nov. 22.

Dr. Boutros largely credits the mandate's high compliance rate to the culture that already existed at the organization.

"From the very first day everyone arrives here, we talk about doing what's right for our patients, doing what's right by each other," the CEO said. "We say if this is not what you're interested in doing, MetroHealth is not for you."

He also said it was important that he not be judgmental of people's decisions and approach the mandate from a point of empathy and understanding.

Part of that was issuing a video in which he spoke to every person who had emailed him. He said some employees emailed him with concerns about side effects from the vaccines, and some argued, "My body, my choice."

"I did explain although I do respect that and wish them well and hope they figure out a place for them to work, it's not going to be at MetroHealth. I am not prioritizing their choices above the patients and their colleagues' safety," said Dr. Boutros.

To reward workers, he said he also surprised every employee who got vaccinated before Oct. 30 with a $250 bonus, which they will see in their paycheck by the end of the year.

Akron, Ohio-based Summa Health, a health system in the Cleveland metropolitan area with about 8,000 employees, announced a mandate in August, too.

According to cleveland.com, the mandate required employees to get their final vaccine dose two weeks before Oct. 31 as a condition of employment. All employees must wear a mask indoors regardless of vaccination status.

As of Nov. 23, about 7,300 employees were fully vaccinated and about 130 were in the process of becoming fully vaccinated. A total of 566 employees received either a medical exemption or religious accommodation. Seven employees were suspended and/or terminated for refusing to get vaccinated.

"It has been received extremely well," Summa Health said in a statement shared with Becker's. "We want to thank everyone who has taken the steps necessary to ensure compliance with our vaccination policy."

Complying with federal mandates

While Cleveland Clinic did not announce a mandate previously, it is now mandating that its employees be fully vaccinated against COVID-19, in accordance with a CMS rule announced in November requiring vaccination for eligible staff at healthcare facilities participating in Medicare and Medicaid programs.

Cleveland Clinic's U.S. employees and those who provide services with the organization must be fully vaccinated by Jan. 4.

"Under the CMS rule, employees who are not fully vaccinated by Jan. 4, 2022, and who do not have a religious or medical exemption that can be accommodated, will no longer be able to work for us," according to a Nov. 12 statement from the health system.

In preparation for the rule, the health system said it has enacted a validation program to collect the vaccination status of employees across the organization's U.S. locations.

As of Nov. 22, 83 percent of Cleveland Clinic employees had received the COVID-19 vaccine.    

Cleveland-based University Hospitals has also informed employees the health system will comply with federal vaccination requirements, according to a statement shared with Becker's.

A hospital spokesperson told Becker's the news was shared with employees on Nov. 5.

"The overwhelming majority of our caregivers are vaccinated against COVID-19," the statement says. "Getting vaccinated is one of the most important ways to protect yourself against severe illness from COVID-19, including hospitalization and death, and to limit the spread to others. Throughout this pandemic, our caregivers have continued to rise to the occasion to serve our community, our patients, and to take care of each other."

University Hospitals has more than 30,000 physicians and employees working at the health system and its partnership hospitals.

Advice for health systems implementing mandates

Dr. Boutros, with MetroHealth, said it is important that any health system implementing vaccination requirements communicates well with employees and ensures they understand the requirements.

"Be respectful, be understanding, be empathetic, communicate, communicate, communicate," he said. "And give people the opportunity of forums to express themselves. As a physician and healthcare executive, it is much more important to weigh the risk to the patient than it is making some staff unhappy or having them leave. I think it's an ethical and moral obligation to protect those who are most vulnerable."

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