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Part Two 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
June 17, 2021

Process improvements at Hartford’s Dunkin’ Donuts Park clinic increase COVID-19 vaccination rate by 207 percent 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. Visit Part 1 to learn how we began the process to improve the site’s flow and increase the number of shots-in-arms per day.

Registration as the Bottleneck

We began by focusing on the Dunkin Donuts Park vaccination clinic’s registration area. We found that the average wait time was being driven up by four causes.

  1. Language barriers—There was often a need to find and then use a translator in the registration.
  2. Health screening—The registration staff was filling out the questionnaire for each patient.
  3. Patients were not ready for the registration process.
  4. Patient information was incorrect or missing from the Vaccination Administration Management System (VAMS).

To improve the registration process, we recommended:

  • Take advantage of the clinic’s bilingual registrars by focusing their efforts on serving non-English speakers.
    • Post colorful “Hablo Español” signs on the plexiglass in front of registrars who speak Spanish.
    • Guide Spanish speakers to those registrars.
  • Move health screening from registration to the waiting area to balance flow in the process.
    • Provide medical professionals in the Waiting Area to assist in filling out the questionnaire. [Having the patient fill the questionnaire out on their own was deemed to be impractical because of the challenges discussed earlier.]
  • Have the patients ready for the registrars.
    • Put up large, colorful signs in the Waiting Area and along the path to Registration to remind patients to have their IDs, health insurance cards, health assessment forms and vaccination card (if second vaccination) out and ready for the registrars.
    • Have the volunteers releasing patients to Registration remind them to have their documents out and ready for the registrar.
  • Have a special registration section for patients not found in VAMS system downloads.
    • The clinic’s team identified this as a downloading issue. Not everyone who signed up for a vaccination was being downloaded properly.
    • The team elected to work to fix this with VAMS.
    • We kept in our back pocket the concept of having a separate path in Registration for those who could not be found in the system at Check-In.

Other Improvement Ideas

  • Place laminated instruction sheets at every Registration station.
  • Designate a volunteer responsible for escorting people from registration to the vaccination area.

Other Process Steps

Other opportunities for process improvements included:

  • Only allow patients scheduled for the active time slot to enter the Gate and Check-In.
    • Having Check-In start to process patients and then have to refuse them because their time slot was not active yet bogged down the line there.
    • In inclement weather, allow all in, but direct those with later time slots to a bull-pen area. 
  • Move the temperature check from just prior to the Waiting Area to the arrival and Check-In area at the main gate.
    • This was also a safety measure to prevent infected patients from moving through the waiting area.
  • Increase the use of visual controls in all steps in the process.
  • Have the patients ready to receive the shot as they enter the Vaccination Area.
    • It was taking some patients up to 2.5 minutes to peel off layers to free up an arm for the injection once the medical provider was ready.
    • If they could not be ready before arriving at a Vaccination Station, the escort should help them get ready as the Medical Provider started the Health Assessment review.
  • Develop one-page laminated instruction sheets for all volunteer functions and use them in the pre-clinic training sessions.
    • This will consistently train the ever-changing volunteer staff and give them a reference to use throughout the day.
  • Cut down the overall number of volunteers and the number of vaccination stations.
    • The need to manage extra people was adding unneeded confusion to the processes.

Revised Process

Based on the modifications we recommended to each part of the vaccine process, the clinic’s steps would become:

We projected the cycle times if our recommendations were implemented as:

 Check-InQuestionnaireRegistrationVaccinationEvaluation
Estimated Cycle Time2.4 m1.5 m with 6.5 wait4.2 m2.8 mE1 – 15 m
E2 – 30 m

This would yield a total estimated cycle time of 32.4 minutes for patients in the 15 minute evaluation bracket and 47.4 minutes for those in the 30 minute evaluation bracket.

The DHHS team decided to make these improvements the following Saturday.

In Part 3 of this article, we’ll discuss the dramatic results that Hartford’s Department of Health and Human Services was able to realize at its Dunkin’ Donuts Park COVID-19 vaccination clinic as a result of key process changes and a continuous improvement mindset.


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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