News Release

Competitive success: New research finds performance feedback at clinics increases flu vaccination rates

Peer-Reviewed Publication

Institute for Operations Research and the Management Sciences

INFORMS Journal Management Science Study Key Takeaways:

  • Clinics that receive performance rankings saw a 12% increase in flu shots and outperformed all others.
  • Clinics that receive performance rankings try to avoid falling into last place; clinics near last place outperform other similar clinics by 23 percentage points.
  • Even a 1% increase in U.S. adult flu vaccination rates can translate to almost $400 million in societal benefits.


CATONSVILLE, MD, August 12, 2021 – 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.

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.”


Link to full study.


About INFORMS and Management Science

Management Science is a premier peer-reviewed scholarly journal focused on research using quantitative approaches to study all aspects of management in companies and organizations. It is published by INFORMS, the leading international association for operations research and analytics professionals. More information is available at or @informs.





Ashley Smith



Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert system.