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

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A high throughput COVID-19 vaccination site was created using Lean principles and tools. Mass-vaccination sites can achieve high output by creating a standard physical design for workspaces and standardised work protocols, and by timing each step in the vaccination process to create a value stream map that can identify and remove all wasteful steps. Reliability of the vaccination process can be assured by creating a visual checklist that monitors the individual steps as well as by building in second checks by downstream personnel. Finally, productivity can be closely monitored by recording the start and completion time for each vaccination and plotting run charts. With 78 personnel working efficiently and effectively together, a maximum throughput of 5024 injections over 10 hours was achieved. As compared with other published COVID-19 mass-vaccination sites, our site attained threefold–fourfold higher productivity. We share our approach to encourage others to reproduce our vaccination system.
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FromanMN, etal. BMJ Open Quality 2022;11:e001617. doi:10.1136/bmjoq-2021-001617
Open access
Applying Lean principles to create a
high throughput mass COVID- 19
vaccination site
Meghan N Froman,1 Matthew P Walser,1 Michael Lauzardo,1 Mark Graban,2
Frederick S Southwick 1
To cite: FromanMN,
WalserMP, LauzardoM, etal.
Applying Lean principles to
create a high throughput
mass COVID- 19 vaccination
site. BMJ Open Quality
2022;11:e001617. doi:10.1136/
Additional supplemental
material is published online only.
To view, please visit the journal
online (http:// dx. doi. org/ 10.
1136/ bmjoq- 2021- 001617).
Received 19 July 2021
Accepted 15 January 2022
1Department of Medicine,
University of Florida College of
Medicine, Gainesville, Florida,
2Lean Enterprise Institute,
Boston, Massachusetts, USA
Correspondence to
Dr Frederick S Southwick;
southf@ epi. u. edu
Quality improvement report
© Author(s) (or their
employer(s)) 2022. Re- use
permitted under CC BY- NC. No
commercial re- use. See rights
and permissions. Published by
A high throughput COVID- 19 vaccination site was created
using Lean principles and tools. Mass- vaccination sites
can achieve high output by creating a standard physical
design for workspaces and standardised work protocols,
and by timing each step in the vaccination process
to create a value stream map that can identify and
remove all wasteful steps. Reliability of the vaccination
process can be assured by creating a visual checklist
that monitors the individual steps as well as by building
in second checks by downstream personnel. Finally,
productivity can be closely monitored by recording the
start and completion time for each vaccination and
plotting run charts. With 78 personnel working efciently
and effectively together, a maximum throughput of 5024
injections over 10 hours was achieved. As compared with
other published COVID- 19 mass- vaccination sites, our
site attained threefold–fourfold higher productivity. We
share our approach to encourage others to reproduce our
vaccination system.
The COVID- 19 pandemic continues in many
regions of the world because of low vaccina-
tion rates. As a consequence, new variants
continue to be generated that can partially
escape the vaccine and have prevented
countries from achieving and maintaining
herd immunity. The highly contagious delta
variant originated in India at a time when
the percentage of the population vaccinated
was only 10% and more recently the even
more contagious omicron variant emerged
in South Africa at a time when less than
30% of the population was vaccinated. Can
Lean manufacturing principles be applied
to improve the efficiency and effectiveness of
mass- vaccination sites to more rapidly achieve
vaccine- induced worldwide herd immunity
and to reduce the emergence of SARS- CoV- 2
The speed of COVID- 19 vaccination is a crit-
ical parameter for achieving herd immunity1
and mass- vaccinations sites were recently
highlighted as effective approach for
achieving this goal.2 One small country with
a unified system of healthcare delivery has
achieved high vaccination rates3; however,
detailed descriptions of their vaccina-
tion procedures have not been published.
Government websites also emphasised the
importance of mass- vaccination sites and
have provided suggestions for their struc-
ture.4 For example, the United States Centers
for Disease Control and Prevention (CDC)
recommends conducting ‘frequent time-
motion studies and staff utilisation reviews to
maximise staff roles’5; however, further details
are not provided. A UK government website
recommends drawing on the logistical exper-
tise of the armed forces, and quotes a Lieu-
tenant Lambert, a Logistics Sea Trainer: ‘As
advisor to the vaccination operation, (I have
engaged) various stakeholders to enable
information flow, understanding and early
identification of emerging issues. This has
included helping design an operational view
of the programme by identifying key perfor-
mance indicators to aid us in spotting poten-
tial problems and providing solutions in a
timely fashion’.6 While some are able to do
so, many local vaccination sites are unlikely to
be able to recruit military logistics or manu-
facturing experts to continually maximise
efficiency and effectiveness.
Given the limited resources and health-
care personnel in many regions of the world,
we strongly recommend that Lean princi-
ples7 and continual learning be applied to
create high throughput vaccination sites.
These approaches can be conveniently
learnt through massive open online courses
(MOOCs) that describe how Lean principles
can be applied to healthcare and are available
through Coursera and the English National
Health Service.8 9 We describe in detail a real-
world example of how we applied Lean prin-
ciples and tools to create a mass- vaccination
site in the hopes that others will emulate our
on February 9, 2022 by guest. Protected by copyright. Open Qual: first published as 10.1136/bmjoq-2021-001617 on 7 February 2022. Downloaded from
2FromanMN, etal. BMJ Open Quality 2022;11:e001617. doi:10.1136/bmjoq-2021-001617
Open access
approach as mass vaccinations are conducted around the
The time of arrival at precheck- in and the time that vaccine
injection was completed were recorded for all recipi-
ents and the lead time calculated for each vaccinee (the
interval between arrival at precheck- in and vaccination
completion) and representative values from each station
were periodically entered into a cloud- based spreadsheet.
The number of vaccinations for each 10- hour session was
On 5 April 2021, the State of Florida released COVID- 19
vaccines to all residents 16 years and older. The sudden
eligibility of over 52 000 University of Florida students
represented a major operational challenge. To create a
mass- vaccination site, we identified a 32 000 square foot
space in our football stadium, the Evans Champions
Club, designed a vaccinee flow pattern with 8 vaccination
stations (online supplemental figure S1) and created a
standardised work sheet for each individual work station
(figure 1) that defined the movement of each vaccinee
and the 5 individual steps or work cycles in the vaccina-
tion process: (1) precheck- in, (2) online check- in, (3) fill
out the consent form, (4) verify the consent form and (5)
vaccinate. To further clarify our procedures, a process
map was created that illustrated how these steps were
combined to achieve timely vaccinations (online supple-
mental figure S2).
We next conducted a series of plan–do–study–adjust
(PDSA) cycles to maximise individual productivity, reduce
unnecessary motion and eliminate time delays. These
improvement cycles were performed on days 1–6 and the
resulting process improvements were implemented on
day 8. To save time, PDSA cycles were conducted simul-
taneously by those conducting each work cycle in the
vaccination process. Online supplemental table S1 lists
the individual PDSA cycles conducted during this period.
For example, initially, we had two precheck- in people for
each station; however, based on feedback following our
early sessions, we learnt that one person was idle half the
time. Therefore, we eliminated one precheck- in person
per station and found that there were no time delays for
the vaccinees. On creation of our value stream map (see
above), we realised that the critical step for assuring effi-
cient flow was the vaccination step. Our frontline observa-
tions revealed that some of our vaccinators were carrying
on prolonged conversations (3–5 min) with their patients
creating unnecessary bottlenecks. For our intervention,
we created a 60- second script for all vaccinators that
included a question about allergies to past vaccinations,
the arm preferred for their injection and a summary of
the potential short- term side effects of the vaccine (local
pain, influenza- like syndrome with possible muscle aches,
fatigue, headache, chills and fever) followed by advice
to seek medical attention if these side effects persisted
for over 72 hours. The script reduced excessive conver-
sations reducing vaccination times. We also conducted
multiple PDSAs to arrange the locations of each work
cycle within the vaccination station. We discovered that
keeping distances to the minimum dictated by infection
control practices (6 feet) minimised walk times reducing
wasted motion. On day 8, we implemented an improve-
ment bundle that included all of changes derived from
our PDSA learning cycles (see the Results section).
Because of the short time frame for the development
of our mass- vaccination site (1 week), involvement of
patients in the development of our site was not possible.
During registration and while being observed following
vaccination, patient comments were shared with two of
our authors (MNF and MPW) and patient suggestions for
improvement were incorporated into our PDSA cycles.
Time observation sheets recorded the five individual
work cycles six times for each workstation (online supple-
mental figure S3). An observer used a stopwatch to time
six individual subjects going through a vaccine station.
We measured walk times and the time spent to complete
(1) precheck- in, (2) online check- in, (3) filling out the
consent form, (4) verification of the form and (5) vacci-
nation. All times were entered on an Excel spreadsheet
and the mean time for each step or work cycle was calcu-
lated. Using these mean times, a value stream map was
constructed documenting a realistic ideal state for the
process (figure 2). The time required to fill out the
consent form was shortened by 2–3 min for those who had
filled out the online form before arrival (approximately
Figure 1 Standardised work sheet showing the individual
vaccine station lay out with the ve work areas, and vaccinee
movement. The diamond symbols mark the locations where
a quality check was performed and the cross symbols mark a
safety check. Each step or work cycle is numbered.
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Open access
one- fourth of vaccinees). Because the 5 areas were 6
feet apart, walk times were only 2–3 s. Reconstituting the
vaccine was performed by a pharmacist team as previously
described following the manufacturer’s instructions10 and
represented a separate process that was conducted in a
site adjacent to the vaccine stations (online supplemental
figure S1).
Vaccinations began on 5 April and occurred each
Monday, Wednesday, Friday and Saturday for 10 hours.
For the first week, all vaccinations were prescheduled by
online appointments, allowing an accurate estimate of
the vaccine demand for each day. As the appointments
began to decrease, we also accepted walk- ins, 150–200/
day. Our highest vaccine demand occurred during
the 1st week and consisted of 5000 appointments/day
(online supplemental table S2). To meet the demand of
5000 vaccinations over 10 hours, we calculated that the
maximum time for each vaccination needed to be 7.2 s
(36 000 s/5000=7.2 s). Our time observation sheet (online
supplemental figure S3) revealed the time required for
one vaccinator to complete one injection varied from
73 s to 138 s (mean: 97 s). To meet the 5000 vaccines
in 10- hour demand, we calculated that we would need
between 10 vaccinators and 19 vaccinators (73/7.2=10.1;
138/7.2=19.1). To assure we had an adequate number of
vaccinators, we chose to recruit 20 vaccinators per session
and set as their goal to inject one person every 144 s or
25 vaccinees/hour. To assure smooth work flow, all other
steps needed to take no longer than 144 s and as shown
on the time observation sheet (online supplemental
figure S3) and value stream map (figure 2): this condi-
tion was met.
Figure 2 Value stream map: a standard workow diagram that describes the work being done in each cycle, the expected
time to complete each work cycle and the percentage of the work that is of value. Consent forms lled out before arrival
enhance the value of step 3.
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Open access
To encourage all volunteers to follow a standardised
work protocol, each job was completely described
during morning orientation. Online supplemental table
S3 provides complete descriptions of the four key jobs
(precheck- in, online check- in, consent verifier and vacci-
nator). The precheck- in consisted of filling out a lami-
nated card that served as a visual control to monitor each
vaccinee’s progress (online supplemental figure S4). In
addition to the person’s last name and birthdate, the
time they arrived at the precheck- in table and time of
vaccination were transcribed on the laminated sheet, as
was the type of vaccine P for Pfizer, M for Moderna, 1
for first shot and 2 for second shot. A box was checked
when online registration was completed and once the
consent form was verified. The verifier then directed the
individual to one of the two vaccinators who reviewed the
allergy history, described possible early side effects from
the vaccine, prepared the designated right or left deltoid
with an alcohol wipe, injected 0.3 ccs of vaccine and
placed an adhesive bandage over the injection site. Indi-
viduals with a history of past allergic reactions were then
observed for 30 min and all others observed for 15 min
as recommended by the US CDC. After completing the
injection, the vaccinator entered the time the vaccine
was administered, and the time the observation period
would end on the laminated card, and finally, signed the
consent form.
The laminated cards were collected by an individual
designated as the ‘runner’ who entered the time of
precheck- in and the time of vaccination in a cloud- based
spreadsheet and then returned the cards back to the
precheck- in desk where the card was erased and reused.
The cloud- based shared spreadsheet was monitored real
time by an administrator. If one station was consistently
demonstrating delays, the administrator went to the site,
identified the sources of delay and solved the problem
with the team.
The runner was also responsible for transporting the
signed consent forms to the end- of- the- line inspection
station (online supplemental figure S1). At this site, forms
were inspected to assure that all parts of the form were
completed before delivery to the county health depart-
ment. Finally, the runners were responsible for continu-
ally monitoring vaccine supply and transporting prefilled
syringes from the pharmacy, replenishing the stock when
the number of syringes dropped below 5. One runner was
assigned to each station.
Other support personnel included ushers who directed
the vaccinees, that included one person in a golf cart
who transported those who had difficulty walking from
the adjacent parking lot to the vaccine site. The total
personnel required for each session was 78: 20 vaccina-
tors, 20 check- in personnel, 10 consent form verifiers, 8
runners, 6 ushers, 2 end- of- the line inspectors, 8 phar-
macists and 4 administrators. With the exception of the
administrators, all others were volunteers from the health
centre and/or the community.
The average time from precheck- in to receipt of vaccine
(lead time) varied from session to session. Following the
implementation of our set of improvements based on
multiple PDSA cycles, we observed a significant reduc-
tion in vaccination times as documented by a shift in the
run chart median vaccination lead time from 13.2 min to
9.2 min (figure 3). For days 26–40, we experienced some
difficulties recruiting volunteers and the presence of new
less experienced recruits during this time may explain
the wider variation of lead times. Additional PDSA cycles
combined with paid permanent personnel could help
reduce the amount of variation in the process and over
time achieve an ideal waste- free state.
By creating vaccine stations that minimised motion,
standardising job descriptions and using a visual control
(the laminated card) to monitor performance, we were
able to achieve a maximum daily output of 5046 vaccina-
tions (online supplemental table S2). From 5 April to 14
May, we vaccinated a total of 35 453 individuals. Although
our county represents only 1.2% of Florida’s population,
our vaccination site alone was able to perform 2% of the
total vaccinations in the state during this time period,
attesting to the effectiveness of our mass- vaccination site.
Multiple mass COVID- 19 vaccination sites have been
described in the medical literature4; however, few peer-
reviewed reports have included detailed logistics or
delivery performance measures. One modest- sized
site used a large conference room and 5 vaccinators to
perform 250–300 vaccinations/day. Vaccinations were
administered for 14 hours each day, therefore, each
vaccinator performed 4–5 injections/hour or less than
one quarter the output per vaccinator of our system.10 A
Figure 3 Run chart showing the median for the daily mean
vaccination lead time (the mean time from precheck- in to
vaccination) before and after implementation of bundle of
improvements (arrow).
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mass- vaccination site in San Diego took place in a 280 000
square foot parking lot and used 300 as compared with
our 78 personnel to deliver 5000 vaccines/day,11 our
approach achieving 3.4- fold higher productivity. Another
parking lot vaccination programme in Florida applied
PDSA cycles, but did not use value stream mapping to
achieve an average output of 8.6 vaccinations/vacci-
nator/hour.12 In Italy, vaccine stations were established in
a large open parking lot and achieved a similar output of
8 vaccinations/vaccinator/hour.13 A college in Montana
created a vaccination site for students and faculty and
conducted two 1- day sessions that vaccinated 807 and 776
individuals. This site achieved a maximum productivity
of 8.2 vaccinations/vaccinator/hour.14 These last three
vaccination programmes achieved comparable produc-
tivity levels that were one- third of the productivity of our
vaccine programme.
We used the work sheets downloaded at no cost from
the Coursera MOOC entitled ‘Fixing Healthcare Delivery
2.0 Advanced Lean’ to design and improve our mass-
vaccination site.8 The stardardised work sheet was used
to design the physical layout of our vaccination station
(figure 1), the time observation sheet to record the times
to complete the individual work cycles and walk times
(online supplemental figure S3), and a value stream map
to assess the value of each process and identify opportu-
nities for improvement8 15 (figure 2). For example, our
analysis revealed that filling out the consent form prior
to arrival at the vaccination site had the potential to
shorten the lead time by 2–3 min, which would increase
the number of vaccinations per hour by 20%–30%.
To assure that registration, consent forms and allergy
histories were accurate, error proofing was designed
into our system: precheck- in was verified by the online
check- in person, the vaccinees consent form was reviewed
by the verifier, allergy history confirmed by the vaccinator
and finally the end- of- the- line inspection for all consent
forms was conducted at the inspection desk prior to these
forms being sent to the health department.
Mass- vaccination sites are particularly suitable for the
application of Lean principles and the US Naval Academy
applied Lean principles to improve the efficiency of
annual vaccinations for 1200 new naval cadets reducing
vaccination lead times (time of check- in to receipt of
the vaccine) from 55 min to 11 min.16 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. Like the NHS team, we
have provided detailed descriptions of each improvement
step so that others inexperienced in Lean principles can
emulate our example.
A limitation of our project was the application of our
Lean improvement tools to a single vaccination site rather
than multiple sites. Second, we depended on volunteers
that often worked for only three–four sessions, a condition
that could compromise the consistent application of stan-
dardised work. However, the first 30 min of each session
consisted of a detailed orientation that included breakout
sessions for each individual job. The orientation instruc-
tors were a stable team of paid healthcentre employees
who were present for all the vaccine sessions, a condition
that maintained continuity and encouraged standardised
work. The impact of a single bundle of improvements
rather than multiple sequential improvement steps was
documented by a formal run chart. Because the semester
ended in mid- May, the time window was narrow for vacci-
nating a significant percentage of student body and
this time limitation required us to accelerate change
by combining multiple rapid PDSA cycles into a single
bundle of improvement interventions. Finally, because
times were entered by the runners, it is remotely possible
that they favoured entering shorter times; however, this
bias would be expected to have been present throughout
the study and, therefore, relative differences between
early, mid and late sessions should be equally impacted.
One of our authors (MG) is a renowned Lean expert who
did not participate in the mass- vaccination site design and
served as an objective referee to curb positive bias.
Our experience reveals that Lean tools can be applied to
mass- vaccination sites to achieve high output by creating a
standard physical design for workspaces, timing each step
in the vaccination process and creating a value stream
map to identify and remove all wasteful steps. When Lean
principles are fully implemented, experts estimate that
productivity can be increased by fourfold and compared
with other published COVID- 19 vaccination sites who did
not employ Lean principles, our output per individual was
threefold–fourfold higher. Reliability can also be assured
by creating visual checklists that monitor the successful
completion of each individual step.18 These principles
can and should be applied throughout our healthcare
systems to reduce waste and improve reliability.
To effectively achieve herd immunity in each region of
the world, we encourage other mass- vaccination sites to
follow our example of applying Lean principles to maxi-
mise efficiency and productivity to accelerate achieve-
ment of the ‘last mile’.”19
Twitter Frederick S Southwick @FS_Southwick
Acknowledgements We would like to thank the many volunteers who generously
gave their time to help our community achieve herd immunity.
Contributors FSS wrote the main draft, lled out the time observation sheets,
created the standardised work sheet and value stream map. MG reviewed
the material and made multiple suggestions for improvement and edited the
manuscript. MNF, MPW and ML designed the original vaccine centre and applied
plan–do–study–adjust cycles to continually improve the processes. They made
on February 9, 2022 by guest. Protected by copyright. Open Qual: first published as 10.1136/bmjoq-2021-001617 on 7 February 2022. Downloaded from
6FromanMN, etal. BMJ Open Quality 2022;11:e001617. doi:10.1136/bmjoq-2021-001617
Open access
suggestions for improvement of the manuscript and approved the nal paper. FSS
was responsible for overall content as the guarantor.
Funding The authors have not declared a specic grant for this research from any
funding agency in the public, commercial or not- for- prot sectors.
Competing interests FSS is a paid infectious diseases consultant for Toyota of
North America.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement All data relevant to the study are included in the
article or uploaded as supplementary information.
Supplemental material This content has been supplied by the author(s). It has
not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been
peer- reviewed. Any opinions or recommendations discussed are solely those
of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and
responsibility arising from any reliance placed on the content. Where the content
includes any translated material, BMJ does not warrant the accuracy and reliability
of the translations (including but not limited to local regulations, clinical guidelines,
terminology, drug names and drug dosages), and is not responsible for any error
and/or omissions arising from translation and adaptation or otherwise.
Open access This is an open access article distributed in accordance with the
Creative Commons Attribution Non Commercial (CC BY- NC 4.0) license, which
permits others to distribute, remix, adapt, build upon this work non- commercially,
and license their derivative works on different terms, provided the original work is
properly cited, appropriate credit is given, any changes made indicated, and the use
is non- commercial. See:
Frederick SSouthwick
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on February 9, 2022 by guest. Protected by copyright. Open Qual: first published as 10.1136/bmjoq-2021-001617 on 7 February 2022. Downloaded from
... Given the limited resources and healthcare personnel in many regions of the world, some authors have recommended the use of lean principles and continual learning. These approaches can be learned conveniently through large open online courses and can be used to create high throughput vaccination sites, as described by Froman et al. [15]. With 78 personnel working efficiently and effectively together, they described a maximum throughput of 5024 injections over 10 h. ...
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To manage mass vaccination without impacting medical resources dedicated to care, we proposed a new model of Mass Vaccination Centers (MVC) functioning with minimum attending staffing requirements. The MVC was under the supervision of one medical coordinator, one nurse coordinator, and one operational coordinator. Students provided much of the other clinical support. Healthcare students were involved in medical and pharmaceutical tasks, while non-health students performed administrative and logistical tasks. We conducted a descriptive cross-sectional study to describe data concerning the vaccinated population within the MVC and the number and type of vaccines used. A patient satisfaction questionnaire was collected to determine patient perception of the vaccination experience. From 28 March to 20 October 2021, 501,714 vaccines were administered at the MVC. A mean rate of 2951 ± 1804 doses were injected per day with a staff of 180 ± 95 persons working every day. At peak, 10,095 injections were given in one day. The average time spent in the MVC was 43.2 ± 15 min (time measured between entry and exit of the structure). The average time to be vaccinated was 26 ± 13 min. In total, 4712 patients (1%) responded to the satisfaction survey. The overall satisfaction with the organization of the vaccination was 10 (9–10) out of 10. By using one attending physician and one nurse to supervise a staff of trained students, the MVC of Toulouse optimized staffing to be among the most efficient vaccination centers in Europe.
Background: Mass vaccination of the global population against the novel coronavirus (COVID-19) posed multiple challenges, including effectively administering millions of doses in a short period of time while ensuring public safety and accessibility. The Government of Dubai launched a mass campaign in December 2020 to vaccinate all its citizens and residents, targeting the population over the age of 18 against COVID-19. The vaccination campaign involved a transformation of multiple commercial spaces into mass vaccination centers (MVCs) across the city of Dubai, the largest of which was the Dubai One Central (DOC) Vaccination Center. It was operational between 17 January 2021 and 27 January 2022. Objective: The multi-phase research study aims to empirically explore the opinions of multiple healthcare stakeholders, elicit the key success factors that can influence the effective delivery of emergency healthcare services such as COVID-19 MVCs, and explore how these factors relate to one another. Methods: To understand more about the operations of the Dubai One Central vaccination center, the study follows a multi-phase design divided into two main sections. The study is conducted by the Institute for Excellence in Health Professions Education (ieHPE) at Mohammed Bin Rashid University of Medicine and Health Sciences (MBRU) between December 2021 and January 2023. To elicit the key success factors that contributed to the vaccination campaign administered at DOC, the research team conducted 30 semi-structured interviews (SSI) with a sample of staff and volunteers who worked at the DOC vaccination center. Stratified random sampling was used to select the participants, and the interview cohort included representatives from the management team, team leaders, administration and registration team, vaccinators, and volunteers. A total of 103 people were invited to take part in the research study and 30 people accepted to participate in the SSI interviews. To validate the participation of various stakeholders, the second phase analytically investigated one's subjectivity through Q-methodology and empirically investigating the opinions obtained from the research participants during phase 1. Results: As of July 2022, 30 semi-structured interviews were conducted with the research participants. The expected results from the project's first phase will be the identification of key success factors, enablers, and barriers of the design and operation of the Covid-19 vaccination center at DOC. While the expected results from the study's second phase will identify patterns of similarities and differences in the ranking of the Q-sets. The final set of results from this dataset will quantitatively interpret the common answers amongst participants and the correlation between the selected success factors relating to the study. Conclusions: The study will provide a comprehensive two-phase approach to obtaining the key success factors that can influence the delivery of high-quality healthcare services such as emergency services launched during a global pandemic. The study's findings will be translated into key factors that could support designing future healthcare services utilizing evidence-based practice. In line with future plans, a study will use data, collected through the One Central vaccination center, to develop a simulation model outlining the process of the customer journey and center workflow.
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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.
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Purpose The distribution and vaccination of COVID-19 vaccines to billions of people worldwide will likely be one of the biggest public health undertakings in history. There has been a large focus on identifying processes to safely, efficiently, and effectively vaccinate large populations. We aimed to describe the development and operationalization of a drive-in COVID-19 vaccine site in a parking garage adjacent to outpatient clinics at University of Florida (UF) Health Physicians and how it was informed by the roll-out of SARS-CoV-2 testing and administration of respiratory vaccinations. Design/Methodology/Approach A technical description and analysis of a drive-in COVID-19 vaccine site. Findings We incrementally increased the number of vaccines performed per day from 300 in the first 2 weeks to 700 an additional 2 weeks later. By the end of January, we completed nearly 14 000 vaccinations. At this capacity, we estimate the site could performed 5000 vaccinations per week. Practical Implications This manuscript provides step-by-step guidance how to develop, operationalize, and implement a sustainable drive-in COVID-19 vaccination site. Originality/Value To our knowledge, this is the first description of a drive-in approach to COVID-19 vaccination. Our findings can help inform other health entities as they develop or expand vaccination efforts that may serve as a template for other sites to adapt.
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The globe is gripped by the COVID-19 pandemic. Mass population vaccination is seen as the solution. As vaccines become available, governments aim to deploy them as rapidly as possible. It is important, therefore, that the efficiency of vaccination processes is optimal. Operations management is concerned with improving processes and comprises systematic approaches such as Lean. Lean focuses explicitly on process efficiency through the elimination of non-value adding steps to optimise processes for those who use and depend on them. Technology-enhanced learning can be a strategy to build improvement capability at scale. A massive online programme to build capability in Lean has been developed by the regulator of England's National Health Service. Beta testing of this programme has been used by some test sites to refine their COVID-19 vaccination processes. The paper presents a case example of massive online learning supporting the use of Lean in the day-to-day operations management of COVID-19 vaccine processes. The case example illustrates the challenges that vaccination processes may present and the need for responsive and effective operations management. Building capability to respond rapidly and systematically in dynamic situations to optimise flow, safety and patient experience may be beneficial. Given the national imperative to achieve mass vaccination as rapidly as possible, systematic improvement methods such as Lean may have a contribution to make. Massive online programmes, such as that described here, may help with this effort by achieving timely knowledge transfer at large scale.
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After SARS-CoV-2 vaccines development came at an unprecedented speed, ensuring safe and efficient mass immunization, vaccine delivery became the major public health mandate. Although mass-vaccination sites have been identified as essential to curb COVID-19, their organization and functioning is challenging. In this paper we present the planning, implementation and evaluation of a massive vaccination center in Lombardy - the largest Region in Italy and the most heavily hit by the pandemic. The massive hub of Novegro (Milan), managed by the Gruppo Ospedaliero San Donato, opened in April 2021. The Novegro massimmunization model was developed building a layout based on the available scientific evidence, on comparative analysis with other existing models and on the experience of COVID-19 immunization delivery of Gruppo Ospedaliero San Donato. We propose a "vaccine islands" mass-immunization model, where 4 physicians and 2 nurses operate in each island, with up to 10 islands functioning at the same time, with the capacity of providing up to 6,000 vaccinations per day. During the first week of activity a total of 37,900 doses were administered (2,700/day), most of them with Pfizer vaccine (85.8%) and first doses (70.9%). The productivity was 10.5 vaccines/hour/vaccine station. Quality, efficiency and safety were boosted by ad-hoc personnel training, quality technical infrastructure and the presence of a shock room. Constant process monitoring allowed to identify and promptly tackle process pitfalls, including vaccine refusals (0.36%, below expectations) and post-vaccinations adverse reactions (0.4%). Our innovative "vaccine islands" mass-immunization model might be scaled-up or adapted to other settings. The Authors consider that sharing best practices in immunization delivery is fundamental to achieve population health during health emergencies.
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The global drive to vaccinate against severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) began in December 2020 with countries in Europe, Middle East, and North America leading the roll out of a mass-vaccination program. This systematic review synthesised all available English-language guidelines and research regarding mass-vaccination for COVID-19 until 1 March 2021—the first three months of the global mass-vaccination effort. Data were extracted from national websites, PubMed, Embase, Medline and medRxiv, including peer and non-peer review research findings. A total of 15 national policy documents were included. Policies were summarised according to the World Health Organisation (WHO) framework for mass vaccination. All included policies prioritised front-line health care workers and the elderly. Limited information was available regarding staffing, cold chain, communication strategies and infrastructure requirements for effective vaccine delivery. A total of 26 research studies were identified, reporting roll-out strategies, vaccine uptake and reasons for refusal, adverse effects, and real-life estimates of efficacy. Early data showed a reduction in SARS-CoV-2 cases, hospitalisation and deaths in settings with good coverage. Very low rates of vaccine-related serious adverse events were observed. These findings provide an overview of current practice and early outcomes of COVID-19 mass-vaccination, guiding countries where roll-out is yet to commence. Infographic:
We describe a large-scale collaborative intervention of practice measures and COVID-19 vaccine administration to college students in the priority 1b group, which included Black or Indigenous persons and other persons of color. In February 2021, at this decentralized vaccine distribution site at Montana State University in Bozeman, we administered 806 first doses and 776 second doses by implementing an interprofessional effort with personnel from relevant university units, including facilities management, student health, communications, administration, and academic units (e.g., nursing, medicine, medical assistant program, and engineering). (Am J Public Health. Published online ahead of print September 9, 2021: e1–e4. )
Purpose Highly effective coronavirus disease 2019 (COVID-19) vaccines have brought hope for ending the pandemic. Unprecedented mass vaccination started first among healthcare workers. The aim of this report is to describe key strategies undertaken by a large hospital pharmacy department to meet the challenges of preparing a large quantity of COVID-19 vaccine doses in a short period of time. Summary MedStar Washington Hospital Center (MWHC) was in the first group of hospitals in Washington, DC, to receive Pfizer-BioNTech vaccine in December 2020. The pharmacy department faced challenges including stringent vaccine storage requirements, a need for specific equipment and workflow, limited funding, and staffing constraints. The pharmacy department’s senior leaders defined pharmacy responsibilities, budgeted for equipment, participated in vaccination center design, and instructed pharmacy informatics personnel. The vaccine coordinators were appointed to oversee all vaccination-related operations. An ultra–low temperature freezer was installed 2 weeks before arrival of the first shipment of vaccine. All pharmacy order entry tools and operating procedures were standardized, and staff training and schedules were finalized by December 15. The first dose of the vaccine was administered on December 16 at the vaccination center. Pharmacy staff members dispensed the vaccine doses and monitored patients. By January 6, 2021, MWHC had vaccinated 3,812 employees with their first vaccine dose, with an average of 228 doses administered daily. Conclusion Key strategies such as systemic coordination, early preparation, detailed planning, operating procedure development, and staff education and engagement proved successful in facilitating preparation of thousands of COVID-19 vaccine doses for hospital employees within a short period of time.