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LEAN and the Vaccine Roll-out

17-May-21

Last weekend I was delighted to attend the Mass Vaccination (MVC) site at the Radisson Limerick to receive my 1st Vaccine dose. I took the opportunity to observe the process from a lean principles viewpoint.

While vaccines are routinely administered in Ireland, there has never been a vaccination program on this scale. The challenge for the HSE was, to simultaneously scale up the vaccination process while making the work easier. Although the process of administering the shot is straightforward, I was interested to observe how the work was organised. Would it be carried out in a way that was most valuable for the patient while also being easy for the front-line staff?

My appointment was at 09.40am. My text message advised me to arrive on site on time but no more than 5 mins before my appointment. I was advised to bring a mask, photo ID and my phone.

Arriving at the Radisson, the organisation was clear on entering the car park. After being parked by a greeter, I observed on the large visual display, that patients with appointments between 9.40-9.50 were advised to enter the queue for registration immediately. To enter the queue, there was a simple verbal verification with a HSE team member to ensure my appointment was in the current “call” window. This was a simple Go/No Go system that limited the flow of patients into the system for the given time slot.

The 2nd step of the process involved a MVC team member physically verifying my text message and photo ID. This check was carried out before entering the vaccination centre and prevented anyone who turned up on the incorrect date or time from entering the system.

Once my ID was verified, I moved forward to the 3rd step of the process, a Covid-19 history check questionaire. Here staff numbers were increased as the verbal questionaire had a longer cycle time than previous checks. I was still outside of the vaccination centre and could be turned away in the event of any issues with the Covid-19 history check questionaire.

At the Covid-19 history check, the checker was ready to record if there was an issue but was not recording the results for all persons checked. Most patients presenting for vaccine will pass the Covid-19 history check, it makes sense to only record the exceptions and turn these patients away before entering the MVC.  

I was directed inside the MVC, being greeted by a multi-lingual greeter, invited to sanitise my hands, and directed into a short queue to attend a registration booth. It was clear by now that the HSE team had put a lot of thought into having patients follow the same steps. There was little variance in the path each patient took to move from entering the system to arriving at the registration booth. At the registration booth, the team member cross checked the personal details I had logged in their system (vaccine registration) against my ID. This quality check started a sequence of recording information in the HSE Vaccine database.

To this point, all preparation tasks were “external” to the activity of administering a vaccine.
Once my personal details had been cross checked, I was directed towards a staff member who either asked the patient to wait or directed them to the next route marker to the vaccination room. The vaccination room consisted of a series of cubicles. Each cubicle had a green / red light outside, this indicated that the cubicle was available to receive a patient or not. A very clever “Pull system” was in place with team members signalling each other on available booths allowing quick allocation of cubicles to patients.

Once I entered the vaccination booth, I was warmly greeted by the clinician. I was directed to sit down and asked to give my name and date of birth to the administrator who confirmed my details on the electronic tablet. The vaccine batch numbers were also entered on the tablet. This was a continuation of the recording of information to the database. The clinician informed me that the vaccine had to be injected into my upper arm and which vaccine I was receiving. He checked there were no objections to receiving the particular vaccine and asked for my consent to administer it. The vaccine was injected with an explanation of how I could expect to feel over the next couple of days. The administrator then gave me a hand-written vaccine card, an after-effects leaflet and explained the details of how I would be contacted for the second dose. 

I was directed to the observation area and asked to wait for 15 mins to ensure there was no unusual reaction to the vaccine.  I was very impressed with the Lean process design and flow attained. As a patient in the system, it was a pleasant experience, the process flowed extremely well. Staffing levels were well balanced to achieve optimum flow. For the system to operate effectively, it was critical that appointments were kept to schedule, this was successfully attained using Pull Systems, Standard work, and visual management.

As a lean thinker, I came away very impressed with the entire process, it was obvious that lean principles had been utilised when setting up the vaccine administration workflow. Well done to the HSE and all supporting teams on designing, rolling out and running a world class Mass Vaccination Centre.