Mass production methods for mass vaccination: improving flow and operational performance in a COVID-19 mass vaccination centre using Lean

Abstract

The COVID-19 pandemic has infected tens of millions of people worldwide causing many deaths. Healthcare systems have been stretched caring for the most seriously ill and lockdown measures to interrupt COVID-19 transmission have had adverse economic and societal impacts. Large-scale population vaccination is seen as the solution.In the UK, a network of sites to deploy vaccines comprised National Health Service hospitals, primary care and new mass vaccination centres. Due to the pace at which mass vaccination centres were established and the scale of vaccine deployment, some sites experienced problems with queues and waiting times. To address this, one site used the Lean systematic improvement approach to make rapid operational improvements to reduce process times and improve flow.The case example identifies obstacles to flow experienced by a mass vaccination centre and how they were addressed using Lean concepts and techniques. Process cycle times were used as a proxy metric for efficiency and flow. Based on daily demand volume and open hours, takt time was calculated to give a process completion rate to achieve flow through the vaccination centre.The mass vaccination centre achieved its aim of reducing process times and improving flow. Administrative and clinical cycle times were reduced sufficiently to increase throughput and the number of queues and queueing time were reduced improving client experience.The design and operational management of vaccination centre processes contribute to client experience, efficiency and throughput. Lean provides a systematic approach that can improve operational processes and facilitate client flow through mass vaccination centres.

Applying Lean principles to create a high throughput mass COVID-19 vaccination site

“… 9 More recently, this same team applied Lean principles to create a mass-vaccination site that enabled 8 vaccinators to inject 1500 individuals/12-hour shift achieving an output of 15.6 vaccinations/vaccinator/hour. 17 We have now applied this same approach to deliver up to 5046 vaccines over 10 hours using 20 vaccinators achieving an individual output of 25 injections/vaccinator/hour. Like the NHS team, we have provided detailed descriptions of each improvement step so that others inexperienced in Lean principles can emulate our example.…”

“…Very recently, a team from the NHS applied the lessons taught in their Lean MOOC to improve vaccination lead times in a small beta test involving 16 individuals 9. More recently, this same team applied Lean principles to create a mass-vaccination site that enabled 8 vaccinators to inject 1500 individuals/12-hour shift achieving an output of 15.6 vaccinations/vaccinator/hour 17. We have now applied this same approach to deliver up to 5046 vaccines over 10 hours using 20 vaccinators achieving an individual output of 25 injections/vaccinator/hour.…”

Recovering staff, recovering services: massive-online support for recovering a paediatric service using Lean and compassionate communication

“…Lean Fundamentals is a massive-open-online-course (MOOC) developed by the Improvement Capability Building and Delivery (ICBD) Group within NHS England and Improvement 31 32. Designed to accept unlimited numbers of participants,33 34 MOOCs are efficient, effective alternatives to traditional training formats and can provide health and care staff with free, large-scale access to S-QI knowledge 31 35 36. The Lean Fundamentals MOOC was designed to develop participants’ knowledge and skills through practical application in a tightly scoped improvement project 31 36.…”

“…Designed to accept unlimited numbers of participants,33 34 MOOCs are efficient, effective alternatives to traditional training formats and can provide health and care staff with free, large-scale access to S-QI knowledge 31 35 36. The Lean Fundamentals MOOC was designed to develop participants’ knowledge and skills through practical application in a tightly scoped improvement project 31 36. An overview of the Lean Fundamentals content and module structure is provided in table 1.…”

“…Following beta-test completion in January 2021, Lean Fundamentals supported COVID-19 vaccination centres to improve throughput and flow 31 36. Though aimed at improving vaccination processes, some participants undertook other projects—including the one reported here.…”