A heightened sense of urgency influenced flu season planning for 2020-21 across California. This was certainly the case in Los Angeles County – center of the state’s coronavirus surges since spring 2020. The specter of an influenza epidemic appearing on top of a COVID-19 pandemic meant that failure to plan was not an option. Over a span of months, existing connections between Los Angeles area hospital managers and County public health personnel matured into a coordinated approach.

Participants in the L.A. Hospitals Coordinated Flu Effort are unanimous that a bigger accomplishment should be recognized. The coordinated flu effort is a model not only for future flu season responses in L.A. County – but for hospital-public agency collaboration in a range of areas. These include future influenza response campaigns in L.A. County and neighboring counties, the critical COVID-19 immunization campaign now unfolding and many more public health campaigns and population health strategies.

The California Hospital Association (CHA), the Hospital Association of Southern California (HASC) and Communities Lifting Communities (CLC)  have also played important roles in developing communication tools as well as the statewide, “FightFluTogether” public awareness campaign and supporting communications to ensure consistent messaging across participating organizations.

Components of the Collaborative

Several elements came together in the first part of 2020 to make the Los Angeles-area flu immunization campaign a true collaborative effort. These included the following.

• Los Angeles Department of Public Health received one-time funding for developing communications tools that can be used this year and beyond.
• HASC brought the statewide FightFluTogether.org campaign to
  the collaborative, joined regular teleconferences, made key connections and involved its strategic communications team and CLC community health initiative with the effort.
• Sharing lessons learned and strategies proven to boost participation by groups with traditionally lower immunization rates.
• A community health partnership of West Los Angeles organizations including Cedars-Sinai, Kaiser Permanente, Providence St. Joseph, and UCLA Health reached out to Martin Luther King, Jr. Community Hospital, Adventist Health White Memorial, and L.A. County Department of Public Health to launch a wider, regional collaborative.

Carolyn Buenaflor of Cedars-Sinai recalled some thoughts that accompanied the effort’s launch in April 2020.

“The public health-hospital collaborative was dipping its toes, somewhat hesitantly, into the flu effort,” Buenaflor, associate director, community health improvement at Cedars, recalled. “We needed to focus on specific goals unique to the group and we narrowed it down to three: unified and consistent messaging regarding importance of getting the flu shot, coordinating flu outreach to provide flu vaccines to vulnerable populations, and sharing of best practices and lessons learned as we navigate flu outreach in a pandemic.”

Another important milestone was the integration of L.A. Dept. of Public Health immunization outreach with hospital efforts. The two had long worked separate paths, several participants agreed.

“I think DPH had some assumptions about the way hospitals work,” said Mary Anne Chern, president of Adventist Health White Memorial’s Charitable Foundation. “It’s good for them to participate in problem-solving with the staff who have boots on the ground.”

White Memorial nurses conduct flu shot clinics for people experiencing homelessness and have identified practical steps that earn trust, Chern said.

The seven-plus months the collaborative has met and exchanged ideas has broken down barriers that existed previously, said Aizita Magaña, director of planning and public partnerships for L.A. County Department of Public Health’s Vaccine Preventable Disease Control group.

“Hospitals and County public health are now working together to leverage relationships and not competing,” she said.

Magaña emphasized the effort’s precedent-setting work, calling it “critical and historic.”

“The collaborative has given us a new foundation to engage partners on their current capacity, needs and resources – and this will significantly inform the coming COVID-19 immunization effort,” Magaña said. “Having relationships and communication through the collaborative with key representatives makes immunization implementation strategies more effective. We hope to learn and share more in the months ahead.”

Lessons Learned

Most gains noted by project collaborators derive from better communication. These best practices fall into two categories – more effective communication between project partners, and more strategic, informed messaging for the public.

Examples of important communications lessons learned include the following.

• Hospitals previously reported COVID-19 results to L.A. County Dept. of Public Health via fax or phone. A new electronic reporting platform has streamlined the process.
• HASC identified area flu clinic locations in a single location on the FightFluTogether.org website and created an immunization outreach social media and messaging toolkit. The association’s strategic communications team offers guidance on specific communications issues and challenges.
• L.A. County Dept. of Public Health held “brainstorming and listening outreach sessions” to learn more about the needs of specific communities, Magaña related. Specific sessions targeted older adults, Native Americans, Latinos, African-Americans, Asian Pacific Islanders and pregnant women.
• Practical trust-building techniques learned during flu immunization clinics and other events are now routinely shared between partners.

One insight gained by clinic teams is that nurses in the field are trusted more if they stand out as health workers by wearing scrubs, Chern of White Memorial explained.

“Success in the field is about so much more than lining people up and giving them a shot,” Chern said. “You have to build trust over years working with the homeless communities. That experience
is what we really have offer to DPH. I hope that in coming years the County will think about funds to really get these shots – including COVID vaccines – out into the communities through the hospitals.”

Other collaborative partners agreed that trust is a key element for any outreach campaign. What’s more, trust works in two directions. Providers need to build it with constituents. They also need trusted partners with strong ties to communities.

One campaign by the Providence Wellness and Activity Center in Wilmington (near San Pedro in Los Angeles County) partnered with the local YMCA and Boys and Girl Clubs, said Jim Tehan, Providence’s regional director of community partnerships.

“One of the keys to success is working with a partner who is trusted by neighbors – as well as someone we know and trust,” he said. “The model that works best is linking up with places that people know and are familiar with.”

The model helps combat the kind of misinformation that can dissuade residents from attending flu shot clinics – or from attending COVID-19 immunization clinics over the coming months, Tehan said.

“There may need to be multiple attempts to convince people to take the vaccine,” he said. “People may need to be encouraged to actually take it – for their own health, and for the health of their neighbors and their children.”

Links forged by the collaborative will almost certainly pay dividends as state and local COVID-19 campaigns press toward distributing the new vaccines and overcoming the virus, Adventist’s Chern underlined.

“We didn’t know each other before, and now I can pick up the phone with counterparts working at the County and other hospitals,” Chern said. “Together we are learning and sharing best practices. I think tasks we have ahead will be easier given that we’re coordinated, connected and communicating.”

Collaborators included the LA Partnership, a collaborative of non-profit hospitals, the three local health departments, HASC and the California Community Foundation, working to maximize community health impact and promote best practices in L.A. County.