Although OSHA regulations require that HBV be made available to health care workers (HCW), the participation rate with the HBV policy is low. Previous studies address characteristics of non-adhering HCW, but do not use this information to subsequently develop organizational strategies to increase adherence rates. OBJECTIVE: Determine the vaccination rates of all high risk HCW to a HBV policy and to evaluate the effect of leadership in improving those rates at a military hospital. METHOD: One hundred-eighteen HCW at high risk for hepatitis B were categorized by selected variables. Univariate analysis assessed the significance of differences between HBV status and the selected variables. A conditional probability model evaluated the response to HBV policy and subsequent organizational leadership actions to improve vaccination rates. RESULTS: Only 61% and 56% of the military and civilian HCW had initiated the HBV series, however, 100% of the housekeepers completed the series. If a supervisor had the HBV, the Odds Ratio that the HCW had the HBV was 8.3 (95% CI 3.3, 21.1). The military HCW completion rate was increased with passive then active leadership to 85% then 100%. The civilian HCW completion rate was increased to 70% then 93% with passive then active leadership actions during a six month follow-up observation period. Surprisingly, directed education and worksite availability had no effect on the nursing group. Leading reasons for civilian nurses initially declining HBV were pregnancy/nursing (36%), needle phobia (28%), no knowledge of availability (21%), no time (7%) and no risk perception (7%). CONCLUSION: Policy alone will not lead to acceptable HBV rates among HCW. Acceptable rates are achievable with both combined passive and active organizational leadership techniques.