Performance feedback at clinics increases flu vaccination rates

Every year the flu threatens the health of millions of people. Experts continue to recommend annual flu vaccination as the best line of defense, but despite these recommendations, flu vaccination rates haven’t broken 50% in more than a decade. New research in the INFORMS journal Management Science seeks to overcome this. The study finds that performance feedback at healthcare clinics can significantly increase vaccination rates. This has important public policy implications. Citing other research, the authors highlight that even just a 1% increase in U.S. adult flu vaccination rates could translate to some $400 million in societal benefits.

Photo by Anna Shvets on

The study, “Focusing Provider Attention: An Empirical Examination of Incentives and Feedback in Flu Vaccinations,” was conducted by Bradley Staats and Robert Niewoehner III, both of the University of North Carolina at Chapel Hill, in partnership with VaxCare, a technology company that partners with clinics to coordinate vaccination logistics. The study looked at 145 clinics in nine different states and tested whether financial incentives or performance feedback might improve vaccination rates.

“We find clinics that got performance rankings grew their flu vaccinations more than all other clinics. Specifically, our experiment led to a 12% increase in flu shots for these clinics,” said Staats, a professor of operations and Sarah Graham Kenan Scholar, faculty director of the Center for the Business of Health and associate dean of MBA programs in the Kenan-Flagler Business School at UNC-Chapel Hill. “We also find that the clinics who received rankings don’t want to come in last – that is, they do whatever they can to avoid the bottom rankings. Because of this, in trying move up, the clinics near last-place end up outperforming their corresponding control clinics by 23 percentage points – a significant margin!”

This research stands to have a very large impact. If even just a portion of the increased vaccination rates go to at-risk groups, this could avert serious health consequences.

“Even further – if most of an increase in flu shots went to seniors, the CDC estimates that this could prevent thousands of hospitalizations,” said Niewoehner, a doctoral candidate in the Kenan-Flagler Business School at UNC-Chapel Hill.

“Our study shows that behavioral interventions like our experiment can improve performance outcomes, even when targeting seemingly immutable trends, like flu vaccination rates. Going forward, we believe our findings hold great promise for improving public health and company operations in general.”

I would like to add a personal note here. Long before the pandemic raised the prospect of defensive vaccinations, I found that ‘flu shots’ was a hot button topic. I get a flu shot every year and I recommend that to everyone I can. In addition, I have an annual post “It’s time to get that flu shot.” Initially, I was amazed at the vitriolic responses from readers. After all, I was just passing along my doctor’s recommendation. So, vaccinations are a very sensitive subject in our culture. For the record, I get a flu shot every year, and I got the Pfizer-Biontec shots back in February and March of this year.


Filed under flu season, flu shot

2 responses to “Performance feedback at clinics increases flu vaccination rates

  1. Myra F Burton

    I love your posts. I, too, get a flu shot every year and got the Covid vaccine (Modera) in March and April of this year. I have had to stop engaging with some people because of their views of what I did. Really not any of their business in my mind! Thanks for your VERY sensible views!

    Liked by 1 person

    • Thanks for your kind words, Myra. And for sharing that. I still don’t totally understand the visceral response of people to vaccinations. Keep moving. Stay healthy!


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