Improvement Opportunities in the COVID Vaccination Processes

Health department officials, healthcare providers (current and retired), pharmacists, medical students, EMT’s, and many others (including process improvement professionals) have been answering the call to help administer the COVID vaccinations to millions of Americans. The complexities of administering the vaccinations are enormous, and include such issues as:

• Communicating to the public changing guidelines and tiers 
• Systems to schedule appointments that can be used by everyone
• Dealing with no-shows and walk-ins and people who show up at the wrong site
• Traffic control and flow (and anti-vaccination protestors)
• Ensuring patients know when to return for a second dose
• Ensuring patients get (and will get) the correct second dose
• Keeping the providers and volunteers safe

In other words, safely vaccinating 330 million Americans is the most daunting, rapidly evolving and multi-faceted acute health issue we face. Now, with much more demand than supply, vaccination sites should use this (relatively calm) time to use the scientific method to re-assess and improve their processes, especially in light of much larger patient surges to come. 

Are the work, improvement and management systems comprehensive and robust enough to safely deliver a huge volume of vaccinations? What have you learned so far in the process, what are gaps you’ve seen and have you fully closed them? What about the gaps you haven’t yet seen? What are you learning from dress rehearsals and varying scenarios? What would the best vaccination process in the world look like?

Challenges in the Current State

As you think about your vaccination sites, we share a few stories and personal experiences from Value Capture team members. We hope these stories will encourage you as you consider your systems and the future real-world stresses you, your teams and patients will be living in the next few months.

Helen Zak shared this story from WBUR, which describes residents’ experiences with the “frustratingly impossible” online sign-up system (the only way to get an appointment). This presents an obvious challenge for many senior citizens (among other populations) in the Commonwealth, who may not have access to a computer or someone to help them schedule appointments. According to the U.S. Census Bureau estimate, 17% of the Massachusetts population is over 65 (estimated to be more than 1 million people). 

Gerald Harris shared that his 86-year-old mother’s MyChart notified her that she was “past due” getting the vaccine. She had not previously  been notified to get the vaccine, and now there are no appointments available. Moreover, Gerald, who is not in an eligible tier, also got a notice in his MyChart that his vaccination was past due. When he tried to schedule an appointment to see what would happen, Gerald was locked out of his account.

Shana Padgett’s parents live in Florida. Her step-dad qualifies based on age, conditions and willingness. He is a light computer user but he cannot figure out how to register. Some grocery stores are vaccine hubs but his local stores are not participating. His PCP and specialist offices are currently not offering the vaccine. Shana is trying to figure out how to get him in a queue.

Questions to Consider

What can health officials do to solve these issues, to ensure all those who qualify in the current tiers are able to make appointments? What scenarios can be considered to ensure complete coverage for all residents? What innovations can be created and implemented before the next surge of patients who qualify for the vaccine?

A Bright Spot – Building Equity into the Process

On the positive side of the ledger, we know of an academic health system that is creating the opportunity to take steps to begin addressing health inequities in the community. The system is utilizing the post-vaccine observation period (15 – 30 minutes) to talk with the patients to determine whether some basic health needs are being met. For example, patients are asked if they have a primary care provider; if not, the health system helps the patient connect with a PCP. Other basic needs are also discussed, such as other vaccinations, and CARES money is utilized for basic living needs, such as utility bills and food. In other words, this health system is working to build equity into the work.

A Few More Questions to Consider

What value-add can you provide your patients throughout this process? Are there even small steps you can take toward building health equity into the work and into the patient experience? Would steps such as those taken by the academic health system constitute a value-add for your staff and volunteers? Might such improvements help your workers recover a bit from the enormous emotional losses they’ve endured for nearly a year?

A Learning – and Sharing – Opportunity

Millions of vaccines have been given, and many valuable lessons have been learned and improvements implemented. Many health systems are sharing publicly what they’ve learned and what works (and doesn’t work) for them, to help peers around the country avoid duplicating systems that don’t work. (For example, see, “Improving the COVID Vaccination Process: Lessons from the Field” and “Salem Health Public COVID Vaccine Distribution” presentations, as well as this Habitual Excellence podcast episode with Arthur Gianelli and Dr. Lucy Xenophon of Mt. Sinai Morningside).

These organizations, and many more, are continually applying  lean principles and scientific-method problem solving to continually improve. Organizations that have such capabilities in place are in the strongest position to meet the oncoming surge of vaccination patients safely. 

A New Sharing Platform That's Open to You

Update: Value Capture has partnered with KaiNexus to bring a free improvement exchange platform -- learn more here:

Now is the Time to Improve Your Processes

If you would like to find out how Value Capture could help you assess and improve your vaccination systems, click here to complete the contact form.