Gabriel Perna | October 13, 2021
It was never a question of “if” for Marc Boom, MD, CEO of Houston Methodist Hospital, it was a question of “when.” As it turned out, the “when” was unprecedented. Boom mandated the COVID-19 vaccine for all Houston Methodist employees and was the first hospital to do so in the U.S.
“We see it as consistent with our culture and our responsibility to keep patients safe. People who work in health care have a sacred obligation to care for patients and keep them safe. Much like with the flu shot mandate, which we’ve done for a dozen years, mandating the COVID pandemic when we know the vaccine is safe and effective, it fulfills that sacred obligation,” Boom says in an exclusive interview with Health Evolution.
The vaccine mandate was announced on March 31st and went into effect on June 7th. A group of 117 employees sued the hospital arguing that it was coercion to make them take an “unproven vaccine.” A federal judge did not agree and ruled in favor of Houston Methodist. He described the comparison by the employees of the vaccine mandate to medical experimentation in Nazi concentration camps as reprehensible.
The ruling gave many other hospitals and health systems the validation they needed to go ahead with their own vaccine mandates. While some health care leaders have hesitated to put in a vaccine mandate due to labor shortage concerns, Boom says more than 2,600 hospitals and health systems mandated the vaccine before President Biden’s federal requirement will make it necessary for all organizations to comply.
Health Evolution spoke with Boom about the backlash from employees when Houston Methodist announced the mandate, why he thinks vaccine mandates actually improve the labor shortage problem rather than exacerbate it, and advice he has for CEOs who are wrestling with this problem.
What kind of backlash did you face when you announced this mandate in March?
It was very vocal, and it came from a small minority. The vast majority of my employees were saying to me, “This is great. I am glad we’re leading this. Thank you for keeping us safe. Thank you for keeping our patients safe.” And then a very vocal, small minority—in fact, the really vocal were only a couple of people—decided to be very vocal. We managed through that. At the end of the day, we managed to keep 99.4 percent of our employees. We only had 0.6 percent of employees who left as a result of the mandate. That’s a very small percentage and was manageable. We were able to quickly refill those positions. We are sorry to have lost those people, but they made their choice. But 99.4 percent of our employees complied with the policy. As a result, we have an incredibly safe workforce and hospital.
We’re on the back end of a very difficult surge from this Summer and this mandate really functioned quite well in all ways we would have wanted. We want to keep our patients safe. We want to keep our employees safe. What we saw was we had markedly decreased absenteeism compared to other COVID surges and a markedly decreased number of employees getting sick.
In the summer of 2020, at peak, we had about 250-300 excess short-term disability filings. These were employees going out in the community and getting COVID. We typically had a lower rate than the community, but it still mirrored the community. That was 250-300 per week. You are out for two weeks if you have COVID. This summer our peak was around 100 excess filings. That means we were preserving 150 per week. With a two-week absence, we were preserving 300-400 employees in the workforce at any given time. In 2020, at the height of that surge, we had 12 employees in intensive care, two of whom passed away. This summer, we had zero employees who needed ICU care. When we looked at it, in the vaccinated 26,000-plus employees, only 0.03 percent required hospitalization. A vanishingly small number. Of the 450 unvaccinated people, the people who got exemptions, we had 1.32 percent needing admissions. There was 44 times the likelihood of getting admitted if you were unvaccinated than if you were vaccinated. We fulfilled our sacred obligation to keep patients safe and our ethical obligation to keep employees safe. We retained capacity to care for the community during a pandemic. I see this mandate, with the benefit of hindsight, as a resounding success.
Marc Boom, MD, Houston Methodist
Did the mandate push anyone initially hesitant to get the vaccine?
When we put the mandate into place, we were already doing well. We were very purposeful in laying the groundwork. We put a bonus program into place and did a lot of education. When the mandate was announced, we were at 85 percent. It was far higher than most institutions. We were 25 percentage points ahead of other Texas health systems. It was the last 15 percent we needed to convince. We got to 99.4 percent. Most people did what they had to do over the course of the seven weeks. It was only those 153 individuals who chose to leave. A couple of people in that group changed their minds, but the vast majority were very dug in and made up their minds. They were falling prey to a lot of misinformation out there.
Based on your experience, what would you say to health care leaders who are hesitant to enact a mandate because of concerns over labor shortages?
During a surge when the community needed us most, we were there for them because of the mandate. We preserved the workforce. It didn’t create a worker shortage, it actually improved what is a difficult staffing time for us. We didn’t have all that absenteeism. What I will say is had we been at 50-60 percent vaccinated when we announced, we would have had a lot harder time. I can’t overemphasize the importance of leadership in this, the importance of planning and focusing on it over time. I think what you’re seeing in some hospitals that didn’t have consistent messaging early on – they hemmed and hawed and waited to do this and weren’t convinced it was the right thing to do – they find themselves in a tougher position. Those are real issues.
If you look at all the institutions that have completed a mandate, they only lose a small percentage of employees. Very pragmatically, if this becomes the law of the land for most hospitals, home health agencies, nursing homes, etc., since you have to do this in order to get paid by CMS…the reality is people who don’t want to get vaccinated are going to represent a small amount of people. They won’t have anywhere else to go to work. At the end of the day, from my perspective, that’s OK. If individuals can’t put patients first and follow the science to do what’s right, health care is not the right profession for them.
Did Houston Methodist experience any problem areas because of labor shortages?
Never. Of course, everyone is challenged throughout a pandemic. Our normal numbers were not adequate to cover those record-breaking surges. We’ve had to bring in additional personnel. But had we not done this mandate, we would have been in a much worse situation. We would have had 300-400 additional people out from COVID at any given time. We lost 153 people who didn’t want to get vaccinated. You can quickly do the math. 153 people in June that we quickly replaced vs. 300-400 people out because of not getting vaccinated.
The reality is hospital systems who don’t mandate the flu shot do reasonably well by coaxing and cajoling and educating, but there’s always 10-15 percent they can’t get to. That’s not as safe if you can get to 100 percent. COVID is the same. It’s that much more important because it’s deadlier and we’re in the middle of a pandemic.
What advice do you have for your fellow CEOs who are wrestling with this challenge?
Be purposeful. Be intentional. Lead by example. Use the clinicians in your institution to passionately listen. Dispel misinformation. Educate as much as you can. And as you mandate, you need to have firm resolve and keep your eye on the ultimate reason you are doing this: To keep patients safe. When you take the high road of keeping people safe then it’s a really easy decision. It takes fortitude, leadership, strength, resolve. You’re doing the right thing. That’s what leadership is all about. Making tough decisions and doing the right thing. We made this decision more than six months ago and I would do it over again in a heartbeat.
Homepage photo credit: HoustonMethodist.org