NOTE: This message was emailed from Alan Levine to all Ballad Health team members on July 20, 2021.
Good morning:
As we shared with you last week, the federal government issued a stringent new COVID-19 rule which applies to health care workplaces throughout the United States, including Ballad Health. The rule by the Occupational Safety and Health Administration (OSHA) is complex and lengthy.
The part of the rule which has become an issue for many is the requirement that employers must have a plan, policies and procedures to determine each employees’ COVID-19 vaccination status if an employer permits exceptions to controls such as masking, social distancing, etc. The main point is that the employer must ensure, at all times, that employees are not exposed to the spread of the virus in the workplace. In the event even one unvaccinated employee is in a room unmasked with the potential to infects a coworker, Ballad Health could be in violation of the rule, with serious implications. Fundamentally, the rule is designed to reduce the opportunity for someone who is unvaccinated and unknowingly COVID-19 positive to infect others and conversely, to protect the rights of individuals who are not vaccinated to not be put at increased risk from others who are unvaccinated.
This explains why the rule literally requires the employer to determine the employees’ vaccination status if we permit anyone to be amongst others unmasked, or without social distancing.
What are our options?
To be compliant with this OSHA rule, there seem to be several choices we could make as a health system:
- Require 100% controls (masking, social distancing, physical barriers) in all areas at all times, regardless of whether the employees are in a patient care area.
- Use the “honor system.” No one must wear anything, and we simply rely upon individuals to disclose their vaccine status when congregating.
- Require the vaccination of all employees, thus eliminating any need for differentiation between team members and the OSHA requirements for various levels of protection.
- As we announced last week, require team members to choose one of two color coded “badge buddies,” with one color indicating vaccination, and the other color indicating the team member does not wish to share their vaccine status, or they are not vaccinated. Thus, when congregating, if someone is wearing orange, then everyone knows that everyone needs to mask. We suggested color coding – rather than an “I’m vaccinated” pin or sticker as some health systems have done – because we believe color coding is more discreet but conveys the same message.
- Implement a voluntary program of wearing something indicating vaccine status. In this case, there would not be orange vs. blue badge, but rather, simply blue, and only if a team member wants to indicate their status. In this instance, where people are congregating outside the direct care setting, if there is anyone not wearing blue, then everyone would need to mask.
Reviewing each option
- With respect to #1: We do not believe this option is ideal. There are many areas throughout Ballad Health where most people are vaccinated, and we want people to be able to congregate, meet and socialize, taking a break from masking and distancing where it is safe to do so.
- With respect to #2: While the honor system might sound good, the reality is that even if we did this, the OSHA guidelines still require individuals to disclose to others their vaccine status if they are not vaccinated. Under this option, if someone was not vaccinated and did not disclose it – and then the group did not mask – it would be possible for that unvaccinated individual to spread the virus, thus impacting the rights of other team members. In addition, Ballad Health would be liable for an OSHA-reportable event and potentially incurring significant fines and penalties. Relying on individuals to disclose their vaccine status (in every room they enter) gets us right back to why folks are objecting – people don’t want to be forced to share their medical choices.
- With respect to #3: As I’ve shared, Ballad Health, at this time, is not comfortable mandating the vaccine, even if it would simplify this whole issue. I do point out that yesterday the Virginia Health and Hospital Association publicly called for hospitals to consider mandatory vaccines for all team members and physicians. Ballad Health at this time continues to protect our team members’ right to make this decision for themselves, despite our expectation that an increasing number of health systems are now requiring the vaccine in order to continue employment.
- With respect to #4: After reviewing important feedback from our team members, which I greatly appreciate, we do feel that many team members have made a valid point about being forced to choose a color, feeling as though this would create an “us vs. them” division within Ballad Health. While I feel differently about that, I also respect there are some strong feelings on this topic.
- Which takes us to option #5. I think this option has merit. If you wish to wear the blue badge buddy, it is your choice. It is an opportunity for you to demonstrate that you chose to vaccinate, and you want people to know it. Alternatively, team members may choose to not wear anything on their badge. Folks who are vaccinated and don’t wish to disclose may choose to not wear the blue badge buddy, and folks who are not vaccinated would not wear anything on their badge, either. That being said, to ensure compliance with the OSHA rule, our policy and practice would have to require if ANYONE in a group is not wearing blue, then EVERYONE must follow the OSHA guidance for mitigating the potential for spread (i.e., masking, distancing, etc.). One reason I like this option is that I have heard from team members who DO want to let people know they are vaccinated. In my opinion, they should have that opportunity without Ballad Health forcing others to disclose something they don’t wish to or be categorized in a way that feels divisive or stigmatizing.
So, with all this said, Ballad Health will go with Option #5.
We will make the blue badge buddies available to any team member who is vaccinated and wishes to wear one. It is voluntary. Our policy, for as long as this OSHA rule is in place, will be that any congregation of people in ANY setting (meetings, lunch, breaks, training, etc.) will REQUIRE masking and social distancing if ANYONE in the group is not wearing a blue badge buddy. This is mandatory, and failure to follow the policy can result in disciplinary action.
What about questions from patients?
Throughout this discussion, Ballad Health has opted to use the color-coded badge rather than providing buttons that say, “I’m vaccinated” – something other health systems and private businesses are permitting. We are sensitive to the concerns expressed by some team members that patients may read such messages and object to being treated by someone who has chosen not to vaccinate. Despite our discrete approach, some patients may yet inquire about why some team members choose to wear a blue badge. This is a fair question, and patients have a right to be assured about their safety. If a team member chooses not to disclose their vaccine status, and they are approached by a patient or visitor inquiring why they are not wearing the blue badge buddy, the team member may simply remind the patient or family member that Ballad Health requires all team members with patient contact to take appropriate steps to mitigate the potential for the virus to spread, including appropriate use of PPE, hand hygiene and social distancing. Ballad Health insists on the use of precautions to protect patients from any pathogen, and this is true with any patient contact situation. It is up to each team member to decide for themselves if they wish to disclose their status to others, but I remind you that when congregating away from patient care areas, it is critical that masking and social distancing occur if anyone is not wearing a blue badge.
Regarding the OSHA CBL
As a reminder, Ballad Health must be able to demonstrate that each team member has completed a COVID-19 training CBL, and must sign an attestation confirming that they are self-screening before arriving to work. The information outlined in this memo supersedes the training material covered in the CBL. This training has been assigned to all team members within HealthStream and must be completed by 7 a.m. on Monday, July 26, 2021. Failure to complete the training on time may necessarily result in suspension from being able to work until the time of completion. The OSHA rules are clear about ensuring team members are made aware of the policy and that we are compliant.
Believe me when I say – despite the laudable effort by OSHA to protect employee health – this rule is extremely complex and comes with significant penalties for non-compliance. We are going to advocate at the federal level for some commonsense changes. It is not our wish to make team members uncomfortable, and in fact, I believe we were doing just fine before this Emergency Temporary Standard (ETS) was put in place. We’ve been at this for 18 months, and throughout it, we have sought to protect our team members, we’ve provided a steady supply of PPE, and we’ve adapted in ways to try to make our workplace safe. Flexibility is the key, which is generally not a hallmark of federal rule-making.
I appreciate the input, feedback and, importantly, your understanding. Your voice in this has helped us make what I think is the best decision we can.
Thanks for all you do, and God Bless.
Alan Levine
Chairman and Chief Executive Officer
Ballad Health
