• Karleen F Giannitrapani, Cati Brown-Johnson, Natalie B Connell, Elizabeth M Yano, Sara J Singer, Susan N Giannitrapani, Wendy Thanassi, and Karl A Lorenz.
• Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, USA. Karleen@stanford.edu.
• J Gen Intern Med. 2022 May 1; 37 (7): 173717471737-1747.

BackgroundIn August 2021, up to 30% of Americans were uncertain about taking the COVID-19 vaccine, including some healthcare personnel (HCP).ObjectiveOur objective was to identify barriers and facilitators of the Veterans Health Administration (VHA) HCP vaccination program.DesignWe conducted key informant interviews with employee occupational health (EOH) providers, using snowball recruitment.ParticipantsParticipants included 43 VHA EOH providers representing 29 of VHA's regionally diverse healthcare systems.ApproachThematic analysis elucidated 5 key themes and specific strategies recommended by EOH.Key ResultsImplementation themes reflected logistics of distribution (supply), addressing any vaccine concerns or hesitancy (demand), and learning health system strategies/approaches for shared learnings. Specifically, themes included the following: (1) use interdisciplinary task forces to leverage diverse skillsets for vaccine implementation; (2) invest in processes and align resources with priorities, including creating detailed processes, addressing time trade-offs for personnel involved in vaccine clinics by suspending everything non-essential, designating process/authority to shift personnel where needed, and proactively involving leaders to support resource allocation/alignment; (3) expect and accommodate vaccine buy-in occurring over time: prepare for some HCP's slow buy-in, align buy-in facilitation with identities and motivation, and encourage word-of-mouth and hyper-local testimonials; (4) overcome misinformation with trustworthy communication: tailor communication to individuals and address COVID vaccines "in every encounter," leverage proactive institutional messaging to reinforce information, and invite bi-directional conversations about any vaccine concerns. A final overarching theme focused on learning health system needs and structures: (5) use existing and newly developed communication channels to foster shared learning across teams and sites.ConclusionsExpecting deliberation allows systems to prepare for complex distribution logistics (supply) and make room for conversations that are trustworthy, bi-directional, and identity aligned (demand). Ideally, organizations provide time for conversations that address individual concerns, foster bi-directional shared decision-making, respect HCP beliefs and identities, and emphasize shared identities as healthcare providers.© 2022. This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply.

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