I'm a director of corporate occupational medicine, I'm board certified in occupational medicine as well as preventive medicine and public health. And the American College of Occupational Environmental Medicine is our main specialty organization. So it's great to meet you all virtually and look forward to hearing about your projects in the future too. Next slide. So I presented this at our ACOM annual conference which is called AOHC for some reason they use a different term. So 3M has a workforce of about 30,000 employees in the U.S. and about 60,000 internationally so we're a global company. 3M Maplewood Center in Minnesota houses a full service clinic and the corporate occupational medicine department. That clinic kind of serves as an urgent care facility. We also conduct executive health exams so like an annual preventive exam and then we have a travel clinic there as well. Most manufacturing sites and research and development centers have an onsite occupational health nurse or an OHN is a term you'll see a lot. 3M has provided onsite influenza vaccination for several decades. We were a really early adopter. I was not there at the beginning. But we were a really early adopter of doing employer onsite vaccination as a non-health care facility and took great pride in that. And then we provided onsite COVID-19 vaccination during the pandemic and continued to do so until it was no longer free from the government. One site that's a part of our pilot program was actually able to continue by bringing an external vendor on site that could process health insurance so they were able to continue. So our onsite COVID-19 vaccinations were manually entered into our electronic medical record which is standard but we also had to manually enter them into the state immunization information systems the IIS. So we do not have a bidirectional or even unidirectional electronic feed and that is a huge contributing issue to being able to scale this project up but we're working on it. So we received the adult vaccination grant from ACOM in October of 2022. We really weren't able to, we got started with like kind of designing what our next slide what our pilot study would be. But we needed to really get our project coordinator on board. So we put most of our funds towards the project manager who is a nurse with a lot of experience with implementing mandatory vaccination programs and healthcare systems. So our goals for 2023 were to reduce vaccine hesitancy and increase vaccination rates for flu and COVID among the 3M workforce at two pilot sites and also to explore the feasibility of a bidirectional electronic feed between our EMR, which is COERDI if anyone uses it, and state immunization registries. If you go to the next slide. So basically we went through IRB, 3M has an institutional review board, did an internal review, we didn't have to do, it was exempted but we still did the process and had all of our informed consent designed and recruitment approved, as well as our basic outline of our study. Recruitment then started at a Minnesota manufacturing site and then one of our sites in Texas which has offices and research and development and it's a very hybrid workforce and remote only employees were also invited to attend that were linked to that center. Informed consent took place electronically, which was a big deal for our company because we don't normally do that, so that was exciting. We did, and then that was followed right by the baseline survey which included demographics, health characteristics and vaccination status. We focused on tetanus, flu and COVID in that order to try to de-stigmatize COVID. There was still a lot of pushback for us from the employer mandate that didn't end up going into effect but we had to start preparing for it. And then also our healthcare group, which is now spun off, they actually, many of those employees did fall within the healthcare mandate that was upheld. So the baseline survey also included an adult vaccination hesitancy scale that was adapted by ACLE published in 2021. There was a study basically where they took the child vaccination, like the parent's views and made it into adult views. And then they, then ACLE then also after that another group trialed it in China and the US and several other countries with the appropriate healthcare authority for that country. And then our modules, they had three choices to do an online module on our 3M Learn system, which took about 10 to 15 minutes, a lunch and learn at the Texas location, which could be virtual or in person, or one-on-one OHN consult where they would really get very tailored information to them. And then any vaccines that could be offered were, otherwise they'd be referred out for ones that they were due for. And then they completed a post-survey in January and February. So we might've missed a few people who were very late in getting flu shots, but we needed to end it at a point. And our goal really was to get people vaccinated with flu before the end of December. Again, post-survey was just any change in health, otherwise the same questions. If you go to the next slide. So our 3M Learn module and the lunch and learn really focused on reasons for adults to get vaccinated. A lot of this content came from the CDC and we just adapted it some. We went through which vaccines are recommended for all adults. So there was slides on tetanus, diphtheria and pertussis, because we wanted to be all inclusive there about influenza and COVID risk benefits and reasons to talk with their healthcare provider if they had certain health conditions to get more guidance on what to do next. Also, there was just some brief information about additional vaccines recommended based on age and health conditions, but it got a little more in depth by referring them to the CDC adult vaccination quiz. And there was a pause in the system where they had to go to the quiz and go through and answer their questions based on their own health status. So that would be on the electronic module. Ways to find their immunization records. We're a culprit here. We've been giving out flu and hepatitis B vaccines on campus for years, and they've not been entered into the IIS. So healthcare providers would not, personal care providers would not even know they're up to date. So if you have a new hep B universal recommendation, if you're 59 or younger to get the hep B series, we have many, many people we have given hep B to that the providers would not be aware of in the community. So we need to work on it on our end too. So they're going to have multiple sources of information for their records. And then we've also find the IIS is not always 100% accurate, right? You don't always have adults. So if anyone's in Texas, we learned something unique for IMTRAC too there, that if you don't sign a waiver or sign a consent for your childhood vaccines to move over as an adult, they just delete them from the system. And I want to say the transition is like at age 26. So that was one of the pushes too at the Texas site was anyone who was younger, please sign your form. And so you don't lose access to those records. And then how to get vaccinated. And there was a little bit more in depth when it came to the lunch and learn, because there was a little bit more time. They had about 30 minutes for that, probably 20 minutes presentation, 10 minutes for questions. Next slide. If they have the one-on-one consult, they received a handout, which we've since revised with the change in the color to the logo. And also just made it a little easier. We took away some of the check boxes on that first page and just left it to comments and next steps. We focused on these four on the first page, because we thought the nurses would definitely have time to cover them. We weren't sure if they would have as much time to cover everything on the right, because they're very busy on site. And we really didn't know what kind of attention span people would have when they met with the nurses and how much time they had to spare from their job. We did a buy-in from the sites to do this, which was really wonderful. And we didn't have a lot of people that participated in the one-on-one consults, but we had about, I want to say, I don't have the notes from the slides showing, but I want to say it's about 15. And they were really well-received. And the manufacturing site wanted more slots, but our nurse had left for a new position at the new spinoff company for 3M. So anyway, we tried to get through, get them to consult with you guys, consult with your healthcare provider if you need additional vaccines. And then if you go to the next slide, and I should also credit CDC. That originally kind of came from CDC, and then we just kind of beefed it up a little bit. So overall results, we invited about a thousand people to participate at the two sites. We had 126 study participants that completed the informed consent and the pre-intervention survey. 120 completed the vaccine education and 113 completed the post-survey. And the award for that, for completing everything was a little tiny 3M soft-shell cooler, but it was very popular. Everybody wants to participate this year. So if you go to the next slide. So demographics, basically it was about split between being 50 and older or under 50. Majority of participants were male. Majority were non-Hispanic white. Most were married. Bachelor's degree or higher for about 54%, but we still had 46% of people who had high school associate's degrees or technical degrees. And the majority were working in a production setting, so in a manufacturing site. And about 68% were on site, and that was pretty much driven by the manufacturing site. Next slide. Thank you. So other health conditions that were reported were diabetes, respiratory problems like COPD or asthma. So things that would indicate, you know, that they might need a pneumococcal vaccine. So trying to plan ahead and look at what our population has in terms of health issues. We had several, not several, but we had less than a handful, six that either reported being immunocompromised or close contact of someone who was severely immunocompromised, and at least 12 that were first responders at 3M or elsewhere. You want to go to the next slide? So again, not that we don't care about people being up to date on tetanus, and we define that as being one dose of Tdap at age 18 or older, and a TD or a Tdap in the last 10 years. It was a way to kind of bring people in, but we had about 80% of people said they were up to date, so very well accepted, right? And then 20% weren't sure. So and probably many of them were up to date. And then in terms of who received the flu vaccine, the prior season, about two-thirds had received it in the past. But only about 30% had received the most recent, at that time, the most recent bivalent booster. So we had some work cut out for us. Now if you look over on the right, it kind of is cut off by the video screen, but most people had had two doses or more. Six people, though, participated who had never had a single COVID dose, which was impressive because this was voluntary participation, and people who were extremely vaccine-hesitant complained about us even doing the program, but we were able to save it by how many people wanted to be in the program, and the site got on board and said all they missed out on was four. So they gave us the green light to continue. And then we had some super overachievers there at five or more doses, so that was good. So we kind of had a bell curve, really, for vaccination status for COVID. If you go to the next slide. So this is that survey I was talking about, the adult vaccine hesitancy scale. So the ones with the Y on the left, those are from the validated scale. The others were additional items we added. So you can see people were pretty vaccine-accepting to start with. I mean, our average was around four, give or take, which on a Likert scale would be agree, somewhat agree. So we started off with a pretty good values, whether it was in manufacturing or not, which was really great in terms of vaccines being important to their health, being important to others in their community, and then we added on family members and coworkers to kind of round out like the socioecological framework. So looking beyond what category is it that makes the difference. And it was a small but statistically significant increase in those factors on the scale. So getting them a little closer to a five, right, which would be a strongly agree. They felt vaccines were effective, getting vaccines was a good way to protect themselves from disease. But then we added a question about, I know which vaccines are recommended for my age group and health conditions. That started at just a tad bit lower than the others, but also had a statistically significant increase, which we would hope from the modules. If you go to the next slide. Almost done. So this was really great since the CDC is our grant sponsor and CMSS. So this was the question from the scale. All routine vaccinations recommended by the CDC are beneficial. That started off at like a 3.5, so kind of between neutral and agreeing, and moved to that 3.79. small but statistically significant increase, same in terms of the CDC being reliable and trustworthy. So small gains are good. And then generally I do what my doctor or healthcare provider recommends about vaccines and the nurse at my site is a good resource. As you can see, our population started off on average agreeing that their provider is really good. Thank you for anyone who is in a surrounding facility near one of our sites. And again, a small statistically significant difference for the provider. The nurse started off high. It stayed the same, driven by the production facility having lost the nurse. That's how much they like the nurse. I think at the other site, in the Texas site, it went up even higher. And then these were odd questions. They're from the validated scale and they have to be reverse coded. So essentially, we reverse coded them so they move in the same direction. So you would like to see an increase. You can see we're kind of starting more in the neutral, undecided category in terms of risks about serious adverse effects or that newer vaccines carry more risk than older vaccines. So when I reverse code them and say, I'm not concerned about serious adverse effects of vaccines, you're neutral and you stay neutral. If we look at it as new vaccines do not carry more risk than older vaccines, we'd like them to think that, right? We're still ending up in that neutral area and we're not really going forward. Plus, as healthcare providers, you'll be very aware of it. This statement's kind of funny to me because older vaccines, especially live vaccines and earlier vaccines that were discontinued were more risky, really, than newer vaccines typically are. So I don't even like that question. So I think we're going to remove it even though it's from the scale. Then I do need, so again, we reverse coded this one so that it would mean I do need vaccines for diseases that are not common anymore. That actually wasn't too bad. And that actually went up. So people don't seem to have hesitancy or think that, oh, measles was a long time ago. I don't need that vaccine. So that was good to see. And it's still also, they agreed with that even more as time went on. If you go to the next slide. So when we do the sum count of all the, you know, one, twos, threes, fours, and fives on the Likert scale. So for the entire survey, pre and post, on the pre-survey, on average, the highest percentage of answers were the four out of five that agree, somewhat agree. And the post total, the primary number of answers was 42% or strongly agree. So we moved the needle a little bit, a little bit. So, and we know that, you know, the more accepting you are of vaccines, the more likely you are to get the vaccination. So I know it's small, but we're happy. And what's really neat, which we'll talk about, I guess, on the next slide, but we had those six people, right, who never had COVID. I don't know if they refused all vaccines, but they refused all the COVID vaccines. One of the six, which I was not expecting any of them to report having gotten a COVID vaccine, one of them did get it. So we were trying to really focus on this middle crowd, the ones that are vaccine hesitant, but there's room to move them forward, and the folks that would accept all, just letting them know what they need so they can go get them. So if you go to the next slide. So overall, we had a decrease of four people who received the previous flu seasonal vaccine to the 2023-2024 one. Now, in general, rates for flu vaccine have been declining since COVID across the country. So maybe a loss of 4% is not terrible compared to the rest of the country or right on par. Again, these are self-report, because we can't go into their record unless they come to see us at that visit. So I can't go into MIC or IMTRAC and see what their vaccination status is. So that's what we have. If we gave out the flu shot, we would know from their chart we gave it to them. And then we had an overall increase of 11 people who had not received that prior, the first bivalent booster, who then received the 2023-2024 formulation, and again, one of those was someone who had never received a single dose before. So we were excited about that. I know it's small, but we are excited about these overall changes. If you go to the next slide. So there was a small but statistically significant change in several factors on the adult vaccine hesitancy scale, including trust in the CDC and in their healthcare provider, which was wonderful to see, suggesting greater vaccine acceptance. We also really started off higher but moved a little bit higher on vaccine acceptance scale. There are no statistically significant changes in concern about adverse effects or the risks of newer versus older vaccines. So we're adding in a couple more slides in the module to address that and see if we can make any headway there. I'm more concerned about the adverse effects, again, than this new versus old argument. I mean, J&J was taken off and advised to really not be used because you don't know everything until you have post-marketing surveillance. So we don't use live polio in the US, right? But you might use it elsewhere where the risk of polio is so high. So I'm more concerned about them thinking about adverse effects as being a very, very, very low possibility. That's what I'd like to see change. But again, you can be concerned about adverse effects and still get the vaccine. And then overall, we had that increase in self-reported COVID vaccination. And if you go to the next slide. So we need to optimize our survey questions and education modules, so we're making some changes there to better address the risk of adverse effects and to be able to assess impact of those changes. We'll continue. I don't think we're going to continue with the one manufacturing site because we're onboarding a new nurse and there's a second nurse that's being hired on. We hope it might work out. But we'll definitely continue at our R&D site. And then we're adding on another plant that's in South Carolina. So anybody in South Carolina, please let me know because we're trying to work with Simon right now. And then we're also adding on a subset of emergency response and other folks, more of an office setting in Minnesota. And we're hoping to increase our sample size and assess the effectiveness of the education options. Because right now, most people did the online module. We'd really like to get some more numbers to look at what's most effective. Our health insurance plan recently switched to using Virgin Pulse, if anyone uses that for your health benefits discounts for your premiums. We used to use Health Partners, their program, and now with Virgin Pulse, it's a little new. They work with us quite well. We've already added on a module for measles about talking about measles vaccines. So we're hoping to move forward. There's already questions about flu and a couple other vaccines, not across the board. So we'd like to see if we can get our module to be assigned so many points if they complete it. If they do the site consult to get more points. But it'd be helpful for us to be able to say, yeah, look at me. We're moving the needle even more if they come and see us, so let's give them more points for those. And that way, this can continue on because we won't always be able to give out coolers and or Stanley cups is our new idea. And then we need to find a solution to electronically connect our record to to make. So honestly, the state registries are completely open to this. And our record, our health care, or EMR has HLA seven messaging, and all of you larger health care systems out there. I am so jealous. And I remember five years ago, before three, I'm having that kind of access and taking it for granted, honestly, not releasing just how wonderful it was. So we have it, but we've got to get the electronic connection set up. And we also need to go through our legal department to to explain to them that we are a health care group, nurses and physicians making health care decisions, we need to know vaccine status, we're not going to tell HR people's vaccine status, they can't go into the record. I feel like there's a misperception somehow that we're not equivalent to any other health care facility and health care role. So we're not going to pass this information on just like we don't pass any else, any other information on. So we're trying to explain that and and and have them see that, see how important it is for the community and also for us to be able to provide better care and to help providers provide better care to our population. And then also, if we can get that set up, we can actually calculate an immunization rate for our sites, which we can't now, I mean, it's an internal number that we would use within within the AHMED department. Again, we're not sharing that with HR, but we don't have a metric to try to achieve. And self-report's great, but it requires people signing in, filling out a survey. I'm shocked anybody filled out the survey with all the hesitancy from the COVID mandate. So I know it was a small participation group, but it was really good for us considering how much hesitation there had been at the site to share their vaccination status with the company. And it's really a credit to the nurses at our site and the trust that they have built to overcome some of those barriers. So and that's it. Any questions? Yes, please drop questions in the chat, raise your hand or just speak up. Hopefully this is interesting to you. To me, this is different than what a lot of you are doing because you have a different viewpoint. You're from the health system perspective and so not as as limited. So I think this is a nice, unique way to think about how to engage people. I love the survey. Damon is super excited about it. So just know that he's going to want the information. I think he's already emailed. Great. And the more people that use it, we can increase the sample size, not just at 3M. And that would be phenomenal. Some of our partners are already looking at Albertsons with the employer group there. They were looking into using it as well. And I mean, gosh, anyone who wants to use that scale, we can actually compare and make our sample size bigger and it would be wonderful. Are the educational modules, are they recorded? They are. So we have it set up in the system. So it'll play through and speak to them as you go through. And there's a delay on the slides. And they have to click that vaccine question questionnaire from CDC so they can't just skip through it. So and they have a question at the end. That's super easy. Heidi's going to know what I'm going to do now. Can I get a link to that? Because, you know, when we think about providing this information, it's not just the seven specialty societies in this grant, but we want to be able to reach out to all the specialty societies and your content is generalizable enough that it's a great starting point for people. So if I could get a link or Julie, if you can send me information, I'm just I'm geeking out over here. That's great. And much of the content comes from the CDC. I mean, some of it's word for word, just to be clear. It's federal. And it should be, right? Yeah. Yeah. I mean, we did add some things in, but but a lot of it is coming from the CDC. So trying to build in those resources, mentioning the CDC at different times in the content, too, so that that was, I think, helpful in getting people's trust back. Great. Yeah, I think this is a great model for others if you wanted to. And again, think about this in your QI interventions. There's no reason why you couldn't have one smaller subgroup that you're doing this type of work with to just see what moves the needle. This to me is it's really cool. And I cannot wait to get that connection with IIS. We've got to talk about how to help you with that. I know. I know we even have money in the budget to use and but we can't they won't take it. So just you guys know, our program is pretty much all in kind, except for our project manager and the coolers, because we do this already and we wanted to do it better. And so our chief medical officer said that's where the money is going to go. And so whenever the data things have changed on entry, we're not going crazy because we have a person who can work on that for us. But I realize we're very fortunate and in a way we're almost like employee health, which is the term you'd use for health care organizations. But we're still employee health for our manufacturing. You know, all of our. So one thing I can tell you is when we updated the handout, I have a very thorough one that we're going to use at our 3M center now. We're not enrolling them in the study. We would have great numbers. When I do my exact physicals and I go back to do my chart and I pull the record back up to finish my note, it's like I love it. Ninety nine percent go and get whatever vaccine I advise them to get within a week. I mean, it's it's amazing. So our numbers would look really good, but we don't have them in the program because we didn't want to make them do the consent program. And we feel like they just need to know the knowledge and they go and do it. But the handout, I think you'd really like the updated handout. I'm happy to share. That would be great to hand out. It's it's based on the CDC's something to give your patients to think about and go home and chew on and maybe they come back and get it done in a week or two or their next visit. Great. No, that's wonderful. OK, I'm seeing lots of kudos in the chat, so great job. And I say the incentive stuff, I joined the AARP for something, so it does work. It really Stanley Cup would make me join in a heartbeat. So I get it. OK, so thank you so much again. Really appreciate it.

Occupational medicine

Vaccination rates

Educational modules

Onsite clinics

Vaccine hesitancy

CDC resources