Mandatory treatments are steadily resulting in less rejection rates among medical professional support groups and parental behavior of preschoolers, but less amongst role models in healthcare, the nursing staff (Davis & Gaglia, 2005; Naleway, Henkle, Ball, Bozeman, Gaglani, Kennedy, & Thompson, 2014).  A selection of four states California, Connecticut, Pennsylvania and Mississippi indicate health promotion programs which mandated flu shots are gaining more results in numbers but, also show the mandatory requirements creates agitation and argumentative discourse amongst many of healthcare’s professional teams.  In this paper, I will take a close look at the problem of these optional opinions and organizational choices to mandated vaccination policies.  Although, seeking community information from healthcare workers, adult students and participants of public service facilities such as libraries, shelters and police stations provides a general access to public information, it is the goal of this paper to discover a specific strategy that can be used to reduce the rate of noncompliant practices.  Current upward trends of influenza have demonstrated that resistance is futile and as a less effective strategy it should not be considered as a best practice in healthcare’s patient to patient exposure.  If mandated vaccinations are required in employment & hiring practices, inclusive staff training of added deterrents and patient safety practices are established as best practices evidence and necessary for patient safety.  Incorporating the vaccination with other standards of care will improve the outcome of delivering healthcare services according to the Ziegler study. 


In the Ziegler study, vaccines were determined essential deterrents for possible sepsis conditions, this was amongst the first successful adjuvant therapy as a prophylactic study in healthcare related to sepsis prevention (Cross, 2014).  Identifying the reasons for immunization rejections among select communities in healthcare, may lead to fashioning better strategies for preventing nosocomial disease.  Information discovery may be formatted to the requirements of participant state department of Health and Human Services and shelter base programs that have participation access to health promotion programs leading to national 2020 Healthy People and the developing 2030 Healthy People, CDC outreach goals.  In order to provide results for an endeavor to improve patient care services and risks reduction healthcare workers should familiarize themselves with the goals of the Healthy People campaign. 

Value Management



An organization who identifies a problem properly apart from its symptoms, has an obligation to clearly define the problem before seeking out a solution. In order to define the problem, you have to find out what it needs.  Symptom management, may inspire the right ideas in order to bring forth a proper solution to the problem – the right fix, to the need.  Kaufman (1998) discusses ideal strategies for a FAST remedy to improve an organizations response to the needs of its customers in his Value management: Creating competitive advantage culture. 

Identifying what the customer needs must always come first as a practice. Leadership will embrace actions necessary to promote resolution of the client needs; especially the foremost need of the customer at hand. In a healthcare environment, my focus on embracing every action designed to promote nosocomial deterrents, while reducing associated barriers, are synonymous to enhancing the safety of the patient and fulfilling their need.  Thus, incorporating healthcare vaccinations together with other nosocomial deterrent practices should be considered part of the medical service community’s embedded Quality Function Design (QFD).  QFD is rarely considered a possibility for the service industries according to researchers Lieuwe Dijkstra and Hans van der Bij, (2002).  But, as a possible function for this professional service towards achieving patient safety goals, vaccination uptake can be incorporated into a QFD as a best practice and nosocomial deterrent standard of care.

As a FAST response, embedded in practice for quick unanticipated burdens related to productivity loss, staffing shortages, and nosocomial outbreaks vaccination uptake is an essential tool to measure for effectiveness of quality care and functional deterrence. FAST, the value management strategy for functional analysis and systematic techniques, are also mapping techniques used in conjunction to value management strategies that addresses a plethora of issues which carry potential negative impacts on production design and service cost to business organizations. In his Value management: Creating competitive advantage article, Kaufman argues for the importance of rapid response in cost reduction and value improvement in achieving worthwhile objectives (Kaufman, 1998). Discovery of competitive advantages versus longer hospital stay durations for patients or rising productivity cost due to staff call-ins and shortages are added burdens of higher demands necessary for shift coverage.  QFD will promote resolute objectives unforeseen through improper value management which goes undetected during strategic planning operations. This form of an organizations capital investment management, where organizations fulfill the cost planning allocated and obligated to its membership productivity, patient stay minimalization, staff training, and skill deployment establishes vital components key to value management methods.

Job planning

As part of the value management system, an organizations job is to establish an effective method and approach that will consistently guide collaborative efforts through opportunities of problem resolutions. Pioneer and Value Management System Creator Lawrence D. Miles is quoted as saying, “all cost is for function … because the customer wants something done” (Kaufman, 1998, p. 3).  In his five-step job plan, Kaufman would suggest job planning begins first by evaluating all available and relevant information pertaining to project series. In a healthcare environment a cyclical pattern of nosocomial transmission and seasonal flu trends associated with viral diseases, such as influenza, have credible resources available through CDC, WHO, and NREVSS. Evaluation of information and data trends from these reputable agencies can provide preliminary steps to initiate QFD. The second step of the planning process is to develop a list of ideas that relate to QFD guidelines or performances but, not as solutions. Implementing nosocomial deterrents such as handwashing, isolation gowning, and flu vaccinations are reasonable ideas against potential hazards of disease transference. In step number three, planners should evaluate the list of ideas suitable for best practice. Improvement of vaccination uptake rates improves risk reduction potentials of shared exposure according to Centers for Disease Control and Prevention. Clustering the best practice methods, such as these nosocomial deterrents mentioned herein, can provide measurable components important to evaluation of scenarios that include financial risk and health-risk reduction during patient care events especially during seasonal flu outbreaks. Step five, brings proposed recommendations to stakeholders for approval and funding of these best practice ideals. Continual use of nosocomial deterrents including influenza vaccination uptake is a building block process, which over time will improve patient safety, awareness. and the overall quality of healthcare services.

QFD, requires step-by-step process evaluations in order to maintain and secure cost efficiency and to guide a successful and disciplined approach for opportunity or to overcome problems successfully. Kaufman, provides Miles’ five-step solution as a FAST response needed for unanticipated critical problems, which I believe can be applied to the healthcare workforce vaccination resistance movement. Development and practice of information building, builds shared support within the organization as collaborative knowledge, skills, and abilities among team participants continues to improve the patient care setting. Training designed to meet the environmental conditions surrounding quality efficiency can promote team-skill development and team confidence among participating members. Throughout each step of the evaluation process evaluation of the value of the training, goals and objectives of the QFD, and review of the idea development provides the opportunity for FAST resolutions. This is a valued lesson which allows for stakeholders and vulnerable patient exposed to unprotected contacts to gain experience from learned behavior vaccination resistant members and develop improvements to a conjoined workforce that will ultimately affect the medical cost’s return on investment (ROI) ultimately at the patient’s expense.

Trend tracking

H1N1, a viral contagion most often seen to cause infections amongst swine. In 2009, this “swine flu” outbreak was responsible for 1.9  per million deaths around the world according to (Chuang, Huang, Liu, Chou, Chang, Chiu, . . . Menéndez-arias, 2012).  In 2005, China succumbed to the “Bird flu.  The social impact of current noncompliant conditions according to Centers for Disease Control, allows potential outbreaks of influenza at pandemic levels.  At the CDC surveillance records of 4.8% to a minimal rate of 4.2% or more are indications of viral confirmed cases amassed.  Current indications suggest that the number of reported cases of influenza, as of February 5, 2017, have increased to 4.8%. This percentage is above the national baseline of 2.2% according to informative records as of February 12, 2017, (




The issue to provide healthcare and no harm, obligates its agents within every medical service group and members of the holistic reform to social responsibilities that ensure reduction rates of nosocomial infections.  A focus targeted on the duty to serve and providing quality patient care, critical urgent care, and patient safety measures can demonstrate effective planning of the healthcare role model and incorporate an evaluation system of best practice evidence.  In the service of healthcare obligations to maintain best practice successfully, intention to prevent the spread of nosocomial contagions is a vital practice of care, contingent on the witness of collaborative actions.  The action of nosocomial deterrent practice would be considered inclusive to the inherent standards; which, patients oftentimes are unaware of risks associated throughout the duration of care.  Practices such as handwashing and donning of gloves before and after personal contact with patients are a typical surveillance event with less than 50% compliance according to joint commission reviews (Sahud, Bhanot, Radhakrishnan, Bajwa, Manyam, & Post, 2010) a result most likely unknown by the inpatient status quo. Such efforts leading to improving practices of handwashing, isolation protocols, and donning gloves between patient-to-patient care and vaccination uptake are critical to ensure the reduction of transmitting pathogens within a healthcare clinical environment.  These deterrents shared in the goal to improve outcome results on a yearly basis are critical to patient care. There are other common practices depended upon location of services (i.e. ICU, OR, ER/ED) where wearing protective personal equipment, sterile techniques, and accurate diagnosis are recognized as higher quality-controlled environments and lean towards improved reduction of health risks associated to the patient’s admitting diagnoses.  The patient’s repetitive exposures to staff is less likely to be compromised by a cluster of nosocomial deterrent practice (Cross, 2014).

Following steps that include early access to medical care, smoking cessation participation, frequent handwashing, involvement in weight reduction, patient education, annual compliance to medical visits and early vaccination can provide reassurance for healthier outcome results another form of deterrent practice.  The National Institute of Health (NIH, 2017) offers suggestions to incorporate into lifestyle behavioral changes which, can be practiced daily (see  But, during the time those infected with influenza and other viral contagions in the care of public health monitoring agencies, according to CDC and NIH epidemiology studies, vaccination is paramount to countering the rapid spread of seasonal outbreaks and other viral disease. 

Finkelstein, Hedberg, Hopkins, Hashmi, & Larson, (2011) describe events of states in demand for vaccines, waiting in anticipation for the uninfected to receive immune defensive prophylactic treatments, necessary to fight a threat for potential pandemic outbreak.  Currently a time at rest, crucial demands for preparedness nursing staff and inpatient vaccination are needed. What is already known about the seasonal outbreak of influenza becomes archaic and dated once agencies enter into the influenza cyclical pattern under duress of its effects on inpatient populations.

The existing knowledge of the H1N1 strain quickly became the scrutiny of 2017 according Potter 1, Stott, Roberts, Elder, O’Donnell, Knight, and Carman (1997) indicating no control studies in support of the effectiveness of vaccination uptake as best practice among healthcare workers. The study Influenza vaccination of health care workers in long-term-care hospitals reduces the mortality of elderly patients. Journal of Infectious Disease objectively dismisses claims that would support flu shot uptake as a remedy to reduce nosocomial exposures due to the lack of evidence-based research. In fact, arguments to this position would suggest a need more investigation to questions of accountability from both sides of influenza uptake and resistance debate to support improvement to the patient problem among seen by healthcare professionals.

An additional idea to present during the job planning of a nosocomial deterrent strategy to achieve stakeholders’ objectives against productivity cost burdens and steps toward improved prevention and a quality health maintenance system remains transparent to the customer.  H1N1’s viral distinction was first identified as a strain with a recognizable pattern which, traces back to the year 1918. Most notable is its distinct and unstable protein cytoplasmic structure.  Researchers Hrincius, Liedmann, Finkelstein, Vogel, Gansebom, Ehrhardt, & McCullers (2015) identify rapid development of cytoplasmic proteins, identified as Protein 1, during laboratory transference of the virus. According to these researchers it is the principal assumption, due to the final location of the tested pathogen, that results of viral contamination occur as a respiratory tract infection (caused by aerosols not necessarily air borne) and not necessarily a pathogenic sequence i.e. from hand to mouth. The majority of symptoms of H1N1 are due to “massive edema formation facilitated by secondary pneumonia” (Hrincius , etal., 2015). In close observation, of hospitalized patients, the researchers noted respiratory symptoms had distinct displays of variant cases from mild to extremely severe. These conditions were also influenced by three major pre-existing conditions such as diabetes, congenital respiratory defects and obesity; fundamental areas for patient education and transparency.

The social impact of efforts to improve preventative maintenance systems for seasonal outbreaks is faced with challenges that influence public safety. Virulent patterns of disease are constantly reemerging as new strains due to the instability of protein 1. The term “spatiotemporal” describes two influences which affect research outcomes in the investigations of vaccine development. According to researchers Bedford, Riley, Barr, Broor, Chadha, Cox & Smith (2015) the interval between space and time emergence creates repetitive challenges from laboratory to laboratory globally, that are faced with a variant of seasonal flu distributions. The importance of sharing knowledge in open forums of communication is expected to lead to a better preventative solution.

Literature review

Vaccination hesitancy and resistance have emerged as a result of distrust, misinformation, and a lack of public knowledge.  Yaqub, Castle-Clarke, Sevdalis, & Chataway (2014), provide details describing the prevalence of hesitation amongst the public at large and healthcare workers who willing may concede to vaccination.  Yaqub etal., in pursuit of an explanation of hesitancy prevalence inform readers of distinctions between hesitancy and resistance. The platform of healthcare related incidents finds an erosion of public trust can be attributed to fears influenced by threatened pandemic outbreaks such as those from 2009, which never occurred. The results from public health narratives may support hesitancy motives attributed to overstated claims pandemic threats and low perceived severity concerns as those debated over viral illnesses. 




self-vaccinating healthcare professionals’ attitudes and their citation frequency: figure 3  

Patient-vaccinating healthcare professionals’ attitudes and their citation frequency: figure 4

General population’s reasons for vaccination attitudes and the number of times such kinds of reasons are cited in the literature we reviewed: figure 5




Studies review

Studies have been conducted on each of these nosocomial interventions yielding results of various efficiencies.  However, considering possible threats and outbreaks of virulent diseases such as influenza, emergency protocols should be incorporated as standard practices of nosocomial prevention and training. Seasonal vaccinations among healthcare agents should be inclusive annual practices to ensure a continual reduction of hospital acquired disease risks are in place, in all areas of operation.  The case for mandatory vaccination treatments is feasible; since, resulting in vaccination rejection rates of 2% among vaccine healthcare workers according to a five-year study conducted at Virginia Mason Medical Center in Seattle, Washington. This first to be known infectious control mandate yielded a 98% uptake compliance rate among healthcare workers (HCW).  Policy accommodations for religious and other considerations were granted due to possible concerns relating specifically to medical diagnoses (Rakita, Hagar, Crome, & Lammert, 2010).  Although, the study highlights a significant percentage for vaccination uptake, it also pays to recognize the small percentage of vaccination resistant HCW which, includes a fewer number of most vaccination resistant healthcare workers in other national studies, who also willing to withdraw their employment further adding to healthcare’s productivity cost burdens.

This combines or bundles nosocomial deterrents into one collective practice including flu shots as an intent action toward best practice behavior and the prevention of influenza as a nosocomial disease.  This proposal suggests the implementation of vaccination uptake as a standard practice incorporated in the procedures for infection control (e.g. handwashing, personal protective equipment, sterile techniques, vaccination uptake) ensuring education of the HCW includes recognizing vaccination uptake, as part of standard infectious control procedures and healthcare no harm responsibility rule; cooperation will act as an added form of patient safety as a core public health value commitment.  After all, incorporating the standard practices of infectious control and uptake responsibility, vaccinating should be treated as a standard of care regardless of the adoption of one’s personal value. Absent from the core value measurement debate surrounding vaccinations, public health is stirred into a melting pot mixture of divergent medical practice ideals from which, agents of healthcare share less responsibility toward effective deterrent actions. Eventually, the accepted reconciliation and collaborate efforts on behalf of patient care must outweigh the diversities which divert the possibility of an efficient QFD.

A perception by the patient-clients of best practice implementation and prioritization demonstrated by the healthcare agents can lead to determining factors that help educate patients about the spread of nosocomial infections. If a vaccination resistant worker, during an active seasonal outbreak of influenza is seen wearing a face mask during patient care, he or she may experience greater collaboration in their patient service. If vaccination uptake workers also wore facemasks while providing patient care during seasonal outbreaks the practice would be an effective demonstration of collaboration by the healthcare team membership. Evidence of best practice would condone collaborative efforts such as these over values of the elitist perspective of resistance. Such recognition in behavior can be an effective tool to provide the highest standards of care amongst an agent’s duty to serve.  This practice when implemented as a standard of care could be taught, expressed, and considered as a professional practice counteracting an inverse of care among vulnerable patient populations.



Prevalence review

TB skin tests, rubella, rubeola, hepatitis B, and varicella vaccinations are required by a large percentage of employers in the United States and rarely rejected under organizational compliance requirements.  Pandemic results of the past are now drawing attention to the sequence of potential risks to require more aggressive preventative strategies (Swan, 2016).   However, according to a (2016) research study by Megan Ziegler, a large majority of these vaccination sequenced refusals, existed among several states opposed to mandating shots of any kind including polio.  This paper seeks to focus on building an effective communication circuit; which, will be key to improving nosocomial deterrent practice and collaboration. In an article published by Centers for Disease Control (CDC), surveillance of seasonal flu vaccination is closely monitored among pregnant women and health care professionals (HCP).  In this study, the CDC has helped build preventative maintenance indicators which, are currently used to monitor outbreak potentials (see Taking steps to improve the understanding of why other ideals promote an objective sequence especially relating to flu vaccinations, an established preventative health maintenance strategy, may provide in-depth information necessary to design improvement to vaccination compliance as seen among other routine vaccination.  Routine vaccination screening for virulent contagions such as tuberculosis, rubella, rubeola, hepatitis B, and varicella vaccines are given regularly and often with less levels of rejection as seen with influenza.  In most cases, we may conclude these vaccine preventative measures are also required by a large percentage of employers and educational systems in the United States.

Epidemiologists, according to researchers have witnessed huge reductions in these pathogenic gateways. Diphtheria, smallpox and polio have seen as high as 100% reduction among each of these cases (Ventola, 2016).  However, among flu vaccines a myriad of ideals has developed into a pattern of recognizable vaccination noncompliant groups. Cohen, & Casken, (2012) identify in their literature review a number of health care providers (HCP), namely nurses, have the most frequent and direct contact with patients.  And, they are number one amongst the highest refusal group of compliance studies when compared to physicians and supplementary medical staff. In the Cohen & Casken lit review it further identifies pre-deposing factors such as “beliefs, knowledge and values” as primary resistant ideals used by all non-compliant persons.  In the planning stage of this endeavor, I have reviewed related literature regarding the hazards of supply shortages and ideals related to members of the medical profession and vaccination hesitancy.  In a review of “A warning shot: The 2004 Influenza Vaccine Shortage” Donya C. Arias provides reasonable arguments in support of preventative measures to avoid vaccine shortages due to underestimated trends of vaccination hesitancy, we include this information along with Cohen & Casken to identify ideals that support hesitancy behaviors and the sustainment of hazardous environmental conditions among healthcare workers and public hesitancy. 

Behavioral theory

As the Theory of Planned Behavior is quite expectant as a hallmark and descriptive behavior of vaccination resistance, according to author Gregg J. (2011) an outcome determined under three spontaneous conditions resulting in a planned behavioral action. First, Gold states is an individual’s perspective of his current situation’s impediments or the facilitators intent to take responsive action. Second, Gold states a relationship to a perspective of consequences for taking action.  Third, are the expected norms resulting from taking consequential actions. These three contingency factors are conditions resulting from an individual’s capacity to make choice decisions based on what is determined to be a self-efficacy principle. Identifying rationale rejections for vaccination coverage; will be identified through participant studies and survey outcomes; sampling will be compared as indicated by standards presented in the Ziegler study.

Research among these conditions will provide a focused review of the opinions these communities believe to be reasonable subjective arguments for their noncompliance to the preventative care measure of vaccination uptake.  Bandura (1977) adds self-effective behavior among an individual’s peer group of a planned behavior is more likely to result into an outcome of change (Bandura, 1977).  Recognizing particular noncompliant ideals may provide a broader solution to engulf concerns regarding preventative outbreak strategies of influenza. But, a continuance to take a bandwagon approach against preventative healthcare maintenance strategies enables us also irresponsibly fail collaborative behavioral risks reductions which, also interferes with preventative standards of care. Simple tasks for the healthcare personnel, should avoid risks potentials and participate in the march towards effective reduction of the spread of influenza. Personnel are not limited to this idea only but, as aforementioned, should adopt early access to care preventions, smoking cessation by example, observable handwashing, weight reduction, patient demonstration & education, annual compliance to medical visits, and early vaccinations.

The National Institute of Health (NIH) offers suggestions for these behavioral change strategies which, each medical personnel can practice independently and routinely during patient access to care (see Exposure to an environment that has limited access to prophylactic vaccine therapy produces a cross-contaminant risk correlation.  High area pollution will along with non-compliant behaviors as smoking, inactive lifestyles leading to obesity, as mentioned earlier will instill “herd affect” patterns among patient behavior potentials; which, vaccination may not be a presented benefit (Kim, Johnstone, & Loeb, 2011).  The sequence of risks potential for patient individuals are anticipated to be less likely as promotional ideals of health than otherwise presented as role model teaching of best practice beneficial strategies.  It would be inappropriate to bypass these concerns and treat only cases that carry better potential outcomes.

However, vaccination uptake in collaborative support to protect patients in hospital care should be a decision established on the principles of Emotional Intelligence (EI) from the goal of public healthcare organizations.  EI arises as conceptual awareness from leadership values that may occur during nurse-to-patient interactions, Patients may take notice of why the caregiver didn’t wash their hands prior to providing care.  Or, patients may request a provider for a spouse or trusted family member to remain at bedside in overnight situations.   The importance of emotional engagement performed between patient individuals, medical participant groups and their organizations is to help establish a quality of leadership needed to reinforce steps toward a safer and improved healthcare system. As a principle engagement of leadership transforming behaviors through dynamics of EI, strong feelings demand attention and are likely to affect cognitions and behavioral processes (Yukl, 2010).  Leaders who take steps to engage constructive use of emotion will become more effective in transforming behaviors of opposition through emotional intelligence.  Their talents shared by supportive organizational processes focused upon using evidence-based practices seek task performance improvements.  Deterring nosocomial outbreaks is essential within the practice of quality leadership centered upon intelligent awareness (DuBrin, 2012). 

Socialization tenets may be key to bringing results sought after by the CDC Health People 2020 90% compliance goal among minority groups of healthcare workers.  Participation or compliance with vaccination through the perceptive intel of protecting patient rights through the recovery processes is an effort that will improve the value management processes of protection for vulnerable patient populations.  Vaccinating voluntarily as well as voluntary compliance of handwashing, wearing gloves between patient to patient contact, and adhering to isolation protocols builds social intelligent engagement between agents having opposing beliefs including artificial ones (Herzig, Lorini, & Pearce, 2017).

State wide collaboration may also demonstrate a great awakening when public response to efforts thwart against medical efforts to improve vaccination response rates fall as a result from the intelligence buy in collaboration of healthcare workers.  Organization values and management commitment must share equally with its membership stakeholders, the mission to build a quality healthcare system in this nation.  Its system must then reflect the connection each of its stakeholder share in agreement towards building a better public healthcare system to protect its citizens nationally. Emotional passions and personal experiences designed by moral persuasion have shown rates for vaccination uptake compliance can be improved.  2013 vaccination coverage improved to 75% from previous 2011 of 67% according to CDC reports researchers Thompson, Shay, Zhou, Bridges. Cheng, etal (2010).  The rates revealed that compliance over mandates were possible.  And, continue trending towards a 90% compliance rate.  The goal of the CDC Healthy People 2020 campaign is attainable as more healthcare workers and staff view their participation as a collaborative support for safer patient care environments.

If there is capable leadership and those who are under the influence of EI it can produce amazing collaboration and resolution according many researchers. However, in opposition to these potentials others perceive EI results are mere “constructive use of … emotion” (DuBrin, 2012, p.481).  Imagine these two differences as seen by subordinate members of a group who have these two personalities to follow,  One leader is seen as an authority figure but, not a leader is seen as having a better understanding by the membership.  The individual with the highest level of EI would be described as the person viewed as being aware of the needs of the membership.  And, that title of Leader could apply to either in title alone, but among this group the one possessing the advantage is the individual who receives the emotional trust from the major portion of members in the group.  Identifying this category of leaders within an organization may be difficult since, they aren’t necessarily specified by managerial appointment or designation.  They are recognized in the way their peers and supportive members engage with them.

Systems adopted to measure levels of emotional intelligence such as MSCEIT, its scoring process determines a person’s EI based on a scale identified as a quotient are highly questionable.  For instance, EI opposition questions can a person who is able to control their anger also manipulate this scoring tool?  We can take into consideration that this and more possibilities exists and manipulating these tools are no better guarantee of emotional measuring outside of human perception. Anger management tools as the psychometric assessment HCR-20.  Mayer, Salovey, Caruso & Sitarenios, (2003) contend there are concerns regarding the reliability of such tests yet, they are still used.  Those who challenge the validity of emotional intelligence itself and whether results of any test can provide consistent results have some degree of concerns about the overall capability of leadership.  DuBrin (2012) suggests, oppositional ideas cannot dismiss that some leaders are more efficient in the use of their skills than others who possess those same skills.  This is the ability which must be shared in order to improve a behavior that responds positively to enforcing all nosocomial deterrents.  A connection with people and understand their emotions is necessary to connect better engagement of what makes a better operating system, healthcare’s goal. 

The CDC report for the 2012–2013 influenza season, there was a modest increase in the vaccination coverage rate among healthcare workers from 67% in 2011–2012, to 72% in 2012–2013 to the current 75% coverage. This is still far from reaching the US National Healthy People 2020 goal of 90% hospitals vaccination rates. The reported increase in coverage is attributed to the growing number of healthcare facilities with vaccination requirements with average rates of 96.5%. However, a few other public health interventions stir so much controversy and debate as vaccination mandates. The opposition stems from the belief that a mandatory flu shot policy violates an individual right to refuse unwanted treatment. This article outlines the historic push to achieve higher vaccination rates among healthcare professionals and a number of ethical issues arising from attempts to implement vaccination mandates. It then turns to a review of cognitive biases relevant in the context of decisions about influenza vaccination (omission bias, ambiguity aversion, present bias etc.) The article suggests that a successful strategy for policy-makers and others hoping to increase vaccination rates is to design a “choice architecture” that influences behavior of healthcare professionals without foreclosing other options. Nudges incentivize vaccinations and help better align vaccination intentions with near-term actions.  Evidence from observational studies suggests that a vaccine mandate increases vaccination rates, but evidence on clinical outcomes is lacking. Although challenging, large healthcare employers planning to implement a mandate should develop a strategy to evaluate HCP and patient outcomes. Further studies documenting the impact of HCP influenza vaccination on clinical outcomes would inform decisions on the use of mandatory vaccine policies in HCP.


Risk Factors

In seeking to identify relative risk factors relating to pre-existing health conditions genetics and genetic risk factors are identified to be most hazardous to the body’s immune systems.  Genetic risk factors first acknowledged as comorbidities result in greater challenges for inpatient influenza exposure.  For the asthmatic, pregnant, and respiratory ailment patient, the flu creates a slight delay in the immune system’s response secondary to a pre-existing health deterrent resulting systematically different by case.  An infected person may or may not show signs and symptoms or even the presence of influenza; however, if there are certain pre-existing conditions, which may enhance the infectious course of the disease contagion it may result in the cause death.  According to the CDC new studies highlight ratios of risk for patients who contract other virulent forms of influenza.  Immune systems processes are needed to recognize and code against viral and bacterial infections.  However, the MBL2 gene part of the body’s genetic coding is responsible for producing a coating of mannose binding lectin 2, an enzyme responsible for the body’s chemical system’s complementary pathway.  In adequate levels of response by the MBL2 allows for invasive secondary infections and is frequently found to be abnormally low in cases resulting in fatality (Ferdinands, 2011).


Recognizing particular noncompliant ideals may provide a broader solution to engulf these concerns regarding preventative outbreak strategies of influenza. However, as we continue to take the bandwagon approach to incrementally improve preventative healthcare maintenance strategies let’s also respond collaboratively to the behavioral risks that interfere with prevention standards of care must be urgently addressed.  The challenge remains according to the Ziegler (2016) study, that refusals go beyond the frequency of regular immunization and behavioral change to stir up and yield high rates of viral flu balances these continue to remain in dispute.  In the January issue of Environmental Health Perspectives researchers argued that exposure to an environment that has limited access to vaccination therapies establishes a correlation between pollutants and viruses which, may increase hazardous risks for viral mutations.  High area pollution will along with such behaviors as smoking, inactive lifestyles leading to obesity, as mentioned earlier will instill “herd affect” behavior when witness by medical personnel noncompliant patterns.  Risk potential among public scrutiny, where vaccination results may appear to not be beneficial, results of sickness may increase to dangerous levels of viral mutations among the public (Kim, Johnstone, & Loeb, 2011). 


The sequence of hazardous risks potentials associated with vaccination resistance, among the role models of healthcare may contribute to the result of vaccination resistance among patients and other noncompliant actors.  It would be inappropriate to bypass this as a possibility, no attempts to expand preventative healthcare strategies to at-risk patient populations can be a result when healthcare workers resent vaccination uptake in their own life status. Their refusal to uptake may extend to choosing not to offer flu shots or other deterrents during their patient care.  Tenacity’s to researched and recorded deterrent practices by overseers of healthcare organizations, public health’s most critical issues regarding viral efficiencies are affecting workplace safety especially in patient-to-patient contact situations.  And, where practicing strict adherence to deterrent strategies to reduce all measurable actions and pandemic threats overcoming and preventing disastrous nosocomial potentials is essential to deploying a fast response in the event of an outbreak.  Collaborative deterrents to improve annual vaccination rate outcomes amongst healthcare workers will set the stage for the CDC’s 2020 Healthy People results.  Targeting vaccination uptake behaviors versus vaccination resistant attacks that offer solutions to improve congruent practices between nosocomial deterrents and external compliances incorporating vaccination.

Yet, continued debates over vaccination uptake versus vaccination resistance as whether shots will provide acceptable protection for personal immune system protection and essential good health-keeping practices, vulnerable population problems have not begun to resolve but, grow.  This discussion synthesizes a valuable need for medical personnel’s embrace of nosocomial deterrent practices.  The effort should stand against threatening potentials of spreading the disease agents within the confines of their direct patient care; environmental participation and cross-contamination.  Recognize the benefits of vaccination uptake over resistance it facilitates evidence-based best practice discussions nationally and must be considered for its potential as a nosocomial deterrent.  HCW should support staff collaboration toward vaccine uptake if feasible and take into consideration its best practice potential to put care for their patient first.