This activity is designed for clinical medical staff who wish to increase adult vaccination rates including influenza, Tdap, PPSV, PCV, and zoster vaccines. The activity has 4 phases – 1) determination of the current state: selection of immunizations, snapshot of current vaccination levels and review of known barriers to immunization; 2) physician selection of interventions to improve vaccination rates from the 4 Pillars Immunization Toolkit; 3) implementation of the selected interventions, and 4) evaluation of improvement. The 4 Pillars™ Immunization Toolkit is an evidence-based, practical toolkit that facilitates vaccination by suggesting 1) convenience, 2) messaging to patients, 3) enhanced office systems, and 4) motivation. This Toolkit was developed with CDC involvement and is up to date on immunization science. The Toolkit has proven effective in those practices that actively implement it.