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Part Three of a Three Part Series: How to Speed Mass Vaccination

The views expressed are those of the author and do not necessarily reflect the views of ASPA as an organization.

By Tony Rodriguez and Mike Beauregard
July 11, 2021

Process improvements at Hartford’s Dunkin’ Donuts Park clinic increase COVID-19 vaccination rate by 207% in five weeks.

In Part 1 of this case study, we discussed the challenges that Hartford Connecticut’s Department of Health and Human Services (DHHA) faced in setting up a COVID-19 mass vaccination clinic within the city’s Dunkin’ Donuts sports and event park.

In Part 2, we explained how changes to the clinic’s pre-registration, registration, waiting and vaccination areas put the vaccination site team on a path to dramatically speeding up the process.

Dramatic Improvement After Two Weeks

The Dunkin’ Donuts Park clinic’s team worked hard to implement our recommendations for changes in staging, flow, signage and support for the clinic’s sign-in, pre-registration, registration and vaccination areas. We returned to the clinic on March 13 to determine the results of the improvements, look for further improvements and find opportunities for refinements.

As a result of more preparation, training, tools and staffing in the pre-registration waiting room, patients received support in filling out their health screening forms there. Once their forms were completed, they waited less than a minute to move to the staging area in front of registration.

Despite occasional bottlenecks in the registration areas, the team had reduced patient registration times from an average of 6.7 minutes to an average of 2.6 minutes.

In the vaccination area, we recommended two people to fill syringes and a decluttered layout for the syringe-filling tables, changes to placement of supplies and syringes and ideas for stamping lot numbers on patients’ vaccination record cards.

That Saturday, it took patients an average of 25 minutes to move completely through the vaccination process, a 31% improvement compared with 36 minutes on February 27. The number of patients vaccinated on March 13 jumped to 430 from 274 two weeks prior, a 57% improvement. More patients could have been vaccinated if more Harford residents had signed up.

Outstanding Improvement After Four Weeks

By March 27, the clinic team’s continuous improvement efforts were really paying off.

The registration process had been bifurcated to serve patients who required language assistance. The bulk of the patients were now visible in the VAMS system. The time in Registration for the downloaded patients ranged from 1.1 to 2.2 minutes. Patients not in VAMS ranged from 2.5 to 5.6 minutes. Overall, the patients sampled averaged 2.2 minutes in Registration.

The nine tables in registration were balanced with twelve stations in Vaccination. The DHHS staff elected to staff more stations that theoretically were needed on average to account for the large wave at the beginning of each time slot. With this approach, no more than three patients were waiting at Vaccination at any given time.

We observed no more than two idle vaccination stations until the scheduled lunch period—a remarkable change from the first week we visited the clinic. The HHS workers were quick lean learners and applied lean techniques themselves too—turning the vaccination tables 90 degrees to allow movement through the area more quickly.  

To improve the syringe drawing operation’s capacity, we suggested an assembly line approach with a spider: one person assembling syringes and one person drawing the syringes with the spider bringing needles and the vaccine to the drawing station and running filled syringes to the stations on regular “milk runs.” Vaccination stations would be filled to a visual kanban of 5 units until after 2 pm, when that would be adjusted down as demand dropped at the end of the day.  

With their new processes and the continued application of lean techniques, the clinic’s team hit 840 vaccinations the following Saturday. They now have the capacity to achieve 1000 vaccinations per day, 100% more than their initial goal.

“The DPA team suggested small process improvements that none of us saw in the aggregate that in fact affected the entire operation. Having their outside-eyes view how all the elements of our vaccination process work together helped us get a larger picture of our flow,” said DHHS Director Arroyo.

According to Arroyo and Palmer, Hartford has applied a few of the practices we suggested at the Dunkin’ Donuts Park clinic in the city’s other vaccination efforts. “We’re helping people fill out their pre-vaccination surveys right as they line up at our mobile clinics and at our health department site, before they register and wait for their shot. Our staff have the clipboards they need. We’ve improved our directional and instructional signage at all locations,” Arroyo explained.

Hartford’s vaccination team leaders are also empowered to make suggestions and quickly improve their processes without having to take their ideas up and down the approval chain. “The leaders and backup staff and volunteers in each section we have put in decision and leadership roles are now more purposeful and powerful in seeing what needs to change and make those changes,” Arroyo added.

The City of Hartford’s Dunkin’ Donuts Park DHHS vaccination team can be extremely proud of the improvements they put in place during five weeks of Saturday clinics. The number of people being vaccinated in one day increased from 274 to a record daily high of 840, a 207% improvement. As the process flow became more efficient, people we queried as they exited the facility after getting their vaccinations unanimously thought the process ran very smoothly.

We were grateful to have had the opportunity to help Hartford’s Department of Health and Human Services make its COVID-19 vaccination process more efficient—helping our state’s efforts to more rapidly approach herd immunity.

Tony Rodriguez is president and Mike Beauregard is senior consultant at Daniel Penn Associates, LLC.


Authors:

Antonio R. (Tony) Rodriguez, CMC, President, Daniel Penn Associates

Antonio (Tony) Rodriguez is a certified management consultant with 35+ years’ experience in encouraging collaboration and progressive thinking to bring about effective change and organizational transformation. With expertise in facilitation/team development, Lean Six Sigma, lean continuous improvement, re-engineering, supply chain optimization, supplier diversity, strategic sourcing, asset management, and productivity improvement, Rodriguez has successfully directed projects for large and medium-sized entities, both public and private, national and international.

Mike Beauregard, International Consultant, Daniel Penn Associates

Mike Beauregard has successfully applied improvement techniques in companies ranging from 10 person start-up companies to Fortune 500 manufacturers. He is a registered Professional Engineer and a Certified Quality Engineer and an eight-time member of the Board of Examiners for the Malcolm Baldridge National Quality Award. He is certified in lean implementation by the Supplier Excellence Alliance (SEA), the aerospace supply-chain consortium, and is certified as a lean-six sigma master black belt by the Management and Strategy Institute.

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