Many news headlines have been highlighting the fact that the US is not vaccinating as many people per day as they had hoped. There is a myriad of reasons, but it often comes down to lack of planning, poor processes, and flow of the vaccines into the hands of those who administer them. But there are many healthcare organizations out there who are well-versed in lean thinking and problem-solving that have created processes to achieve the necessary goals for number of people vaccinated per day. One of those organizations is Salem Health in Oregon.
Today I am joined by Team members, Pam Reznicsek and Whitney D’Aboy, from Salem Health to talk about their vaccine clinic and how they are using continuous improvement methods to meet and exceed their goals for getting their community vaccinated.
Additional resources about the vaccine clinic:
Webinar: Salem Health Public Vaccine DistributionClinic Walk Through VideoInformation and registration page
Peter Mariahazy: Thank you for tuning into the lens I’m your host Peter Mariahazy.
Peter Mariahazy: Many news headlines have been highlighting the fact that the US is not vaccinating as many people per day as they'd hoped. There are a myriad of reasons, but it is it often comes down to a lack of planning processes and the flow of the vaccines into the hands of those who administer them. But the good news is there are many healthcare organizations out there who are well versed in lean thinking and Problem Solving that have created processes to achieve the necessary goals for vaccinations administered per day. One of those organizations is sailing health or going to settle and health in Oregon today I’m joined by team members. Pam Reznicsek and Whitney D’Aboy from Salem health to talk about their vaccine clinic and how they're using continuous improvement methods to meet and exceed their goals for getting their Community vaccinated thank you both for joining me today. Well, will each of you introduce yourselves and tell us about your role at Salem Health and your role in the development of the code vaccine clinic Pam why don't you kick us off.
Pam: Okay um hi I’m Pam Reznicsek, I am the Kaizen Learning and Development Consultant here at Salem Health and I’ve been here at seal help about. Almost 17 years now working in primarily in the registration department and work my way into leadership and now into the kaizen promotion of this. And I assisted in the coven kind of host vaccine clinic really in the problem solving along with the revenue cycle teams, I really help develop their processes so now. How this is going, you know how do we, how do we bill and how do we actually implement streamline registration and those types of things so that's kind of. My expertise, I also actually worked at the vaccine clinic during registration and training we brought on the National Guard, so that we have more hands-on deck to kind of help through the process and that's where I assisted with the workflow to help.
Peter Mariahazy: Whitney, how about you?
Whitney D'Aboy: hi my name is Whitney D’Aboy I’ve been with sales health for the last 10 years and I’ve been the Manager of our Kaizen Promotion team for the last two years. I was very excited to get the opportunity to help design our clinic flow, both internally for our employees and how do we actually get our own staff vaccinated as well as how do we then replicate that out into the Community, so we can really start to vaccinate our Community Members as well.
Peter Mariahazy: Thank you Whitney you know, since you, you were really instrumental in setting it up, can you walk us through the process at a high level and then maybe you know Pam can kind of help close it out?
Whitney D'Aboy: Absolutely, and so what was really innovative and really supported the ability to get a clinic up and running, within two days I was that we, our lean office, partnered with our HIC structure, so we actually activated incident command, where we had our incident commanders we had section chiefs, including planning operations finance all of the above, right. And, and we were actually able to assign your called scribes we actually have a lean person. In our office tied to each of the different section, so that way they can really start to help each section design their piece of the COVID clinic puzzle, and so I was tagged in with planning and our goal was to design a workflow that could accommodate 2000 plus vaccines administered a day. And it was kind of funny we weren't given a location, we didn't know where we're going to be doing this we didn't know if we'd have wifi available. So epic may not have been an option, our electronic medical record, but they said high level start designing what this vaccine clinic would look like. From there, it was actually kind of fun, so we think within one day we actually found out, we had our state fairgrounds available to us. We still didn't know if we'd had white fi so we had to think very quick and crude what is something that we could create that could move people through about 2000 plus people through in one day.
We made the process maps lots of visuals were included in this planning process and our goal is to really just keep it as simple as possible, how do we move people through. Where the process actually tells the people where to go and it as simply as possible as well, so I think there was a lot of great learnings that we had along the way again when you start out quick and crude we actually started with paper everybody was signing paper consent forms and paper co a's and all these types of paper things, of course, that creates issues on the back end of how do we actually start to understand and When are they do for their second dose because nothing's in the medical record of that point. What was great as we're able to then start with something quick and crude we had paper signs up even because we weren't sure the exact flow just yet, so when we open the clinic that day, we had everybody on paper, and then we started to just quickly check and adjust every single bit in in the beginning, so we knew we didn't have a perfect flow because we designed it within 48 hours or less and then we were just kind of gave ourselves the grace to basically say all right we're up and running, we had a test population of about 500 people come through and where we are trying to just understand where the hiccups along the way, and then we just quickly checked and adjusted we actually that first day identified those that had mobility challenges, how do we accommodate for them so that wasn't something in our original design, because we were just trying to think high level 2000 people. So that's when we started to create okay well, maybe there's like a fast track pass where we can bring them kind of through as quickly as possible um so they wouldn't have to stand in line we also created the
fragile population flow, where they would come in through a whole separate entrance and have their own station available to them, so that way they didn't have to commingle with kind of more general public. And so it was really, really great to be able to have that structure in that partnership to really harness different leadership roles around the organization. To really use their expertise and how to design, something that was quick and crude and then everybody was just in that mindset of how do we just checking the just as quickly as possible so that we can just be fluid throughout the entire the entire process.
Peter Mariahazy: Thank you Whitney and I love that phrase quick and crude because then that gets handed off to Pam to get it to smooth and easy right.
Pam: Yes, so, to whitney's point, we had the paper process right, so its first day maybe I think it was actually a little bit further than the first day. We were doing people registrations right, so there was some concerns about how do we get the records, how do we get the reporting and we need to get this into the electronic health records, so now, what do we do so that's where I would spend a bold in with the revenue cycle team. And again just actually pulled in by the VP of finance saw me and all hey, we need to do some problem solving around road cycle, with the specs in clinic come with me and so kind of off we went and through that day we kind of did a lot of Problem Solving the team was working very hard to get those registrations in there and the team on site like scanning in the documentation, so we can have those records to be able to send out for reporting and make sure that we got all of those things going and then really just thinking about Okay, now that we know a few days in about how many people are coming through now how do we start planning and streamlining the process so I actually helped probably within the first week of vaccinations, we were we were steep we were full steam ahead right, we were seeing you know over 2000 people a day the governor's like we need to keep moving Oregon at that point. When we started our clinic was about 25% of the vaccines that we had received as a state were actually given in the states, and so there was a concern that we may actually lose those because you know they do have a time limit and for storage and things like that so she partnered with us, as well as Marion Marion county has been kind of our partner from the launch. And we got resources from the National Guard to actually help even continue growing and so that's where I came in was helping with now that we have National Guard, how many people do we really need to have for this flow. So doing some timing, we have kind of two registration flows right so we've got one that we're really encouraging the Community to do where you can sign up for my chart schedule ahead of time get all your documentation comes in your about three and a half minutes and away you go your vaccine first is our other workflow where people don't want to start the my chart they're doing paper basically handwritten paper that we enter a full registration into our system takes about anywhere from 10 to 15 minutes for those full registration. So how do we manage the flow between those two? Registration close rate so, on average, you know how many people are coming in, so we could actually take the numbers and kind of plan out the staffing for the registration team. Based off of the cadence of check ins and things like that, so that. we knew how many from a scalable perspective if we were to say now do 3000 people how many people would be needed. When he was doing similar work at the same time around, how many people we needed a vaccine versus watching and we had multiple different roles that we have within the clinic so that's kind of how we help support it and I would say that one of the key things was replicating the clinic kind of workflow like we had started our own internal vaccination clinic and we vaccine we've actually added our organization very quickly. So I would say, for others, thinking about that you have a flow, that is in existence if you're vaccinating your people, so there is something there that can actually be used as a model. Even though we stood up the thing in two days we kind of had a structure that we can build, I would say, maybe three or four days just for our own team that we had been using for two weeks, and also revising so again it's really starting something. To Whitney’s point directionally where it needs to go and then, as you build the structure, you can kind of check and adjust I would say it's continuing to check in and just you know go.
Peter Mariahazy: Thank you Pam. So you kind of teed up the next thing so I’m going to ask each of you to kind of give us give us. If you if you're starting this process now or you're working with a whole new organization that hasn't done this yet give me the top two or three, obviously people can only absorb so much at a time, two or three considerations that they need to consider in developing the process. Whitney, what do you think what's the top two or three things they really need to think about?
Whitney D'Aboy:I think what really made our successful with that partnership with the HIC structure and so having those different leaders throughout the organization with their different expertise at the table, helping with their lens to help design what this could look like, I would also say we need to vaccinate, we need to vaccinate quickly so how do you remain as quick and crude as possible until you get kind of an understanding of what the flow could be like but as you're checking and adjusting and then you can really start to move into what does so know of this process, look like.
Peter Mariahazy: Great and Pam, what are the top two or three things you tell somebody who's just about to set it up?
Pam: I would echo the quick and crude. I was thinking keep it simple, so you know, for registration, I would say the for registration here at Salem Health we get a lot more information so what are the minimal things that we actually need? So, really thinking about what you need in the workflow and just look at the bare minimums and start there because when you start with the bare minimums of like what do you need to actually deliver the vaccine. And me all the things that are needed for the vaccine and then build upon it, because once you're using the process you're going to learn and evolve I would say. It really speaks to our lean journey in Salem health that we like frontline staff and leaders it's not just a few people doing this planning it's literally everyone who's working in the workflow is checking and adjusting and Problem Solving as they work so.
Peter Mariahazy: I was just gonna say Whitney you kind of talked a little bit about starting the process and doing you know process mapping and bringing the various people together that are experts. So anything else you can think of that just got you started and getting the thinking going quickly?
Whitney D'Aboy: What was really great was we actually had a very, very high level process map right, so we need them to somehow get their paperwork and then somehow, you know. There was conversation of okay well where do they fill out the paperwork? And then we're like well let's give them a pen and they can do it in the car right, so we just had a very, very high level, and then, once we identified our space we had a printout of our process map and we actually took it there with us to walk it, how would this actually physically look in this space? And so that was really instrumental we did that on like day one design day to walk it and day three is the day we launched. So that's where it was just a matter of we didn't overthink it like I said we didn't even think of like oh gosh people with mobility challenges, how do we accommodate. If we had spent all the time on Monday baking and all the What if scenarios, we would have never been able to launch and so that's where I would say that walking the space and then that afternoon, so it was a Tuesday afternoon we actually started being like okay well if this is going to be here let's start you know, putting tables out, so we can really start to visualize it. And then, again we had every single section chief from our HIC structure, whoever was on that week President, so they can like our safety officer was thinking like okay well if this is where the tables are going to be and we're going to have people walking this distance, how do we make sure that they don't trip over something right so she kind of had her lens going of what would make sense as we're designing So while we had a high level visual what really made it important, and I really think this enforces the concept of go and see is we were designing it while we were seeing it so since we didn't have the people on site, yet we were able to kind of all let's move this table back here, and what we had come to the line move this way and we can move this over here, and so we truly were just did we had a again that high level thought in our minds, but we were able to just design, all together, as a group, on the site, which is very, very valuable.Peter Mariahazy: I think it's great that is that you started the process before you even knew which space you're going to end up with, I mean that's what's to me very intriguing is to say that, and so anything Pam to add regarding starting the process, I know you can have came in a little bit downstream but.
Pam: No, I think we covered most of them, I would say that you know once things have got their flow we've created standard work on things right, so their standard work for people doing vaccines standard work for people who are drawing vaccines ahead of time, so we have people who are preparing the vaccines and kind of distributing them out, and so, and then visual management. And I would say again in the background, the incident command structure is really keeping track of data right so. How many people are flowing through what's our supply look like, how do we need to check and adjust so it's a system in the background that's informing the flow in the actual operations so.
Peter Mariahazy: So give us give us a couple of the challenges you faced along the way, what are some of the things that you went oh geez and a really kind of caused you to you know sit down and need a cup of coffee?
Whitney D'Aboy: At the beginning, and when we were doing so many quick and crew changes right so we're like oh gosh, we need to set up this, we need to do that and it was hard to keep everybody informed of all the changes so it really reinforced the concept of like a visual quick and easy board of some kind. Or even huddles right So how do we take the day off like okay guys, these are the changes we made yesterday, this is why were they were changed and keep in mind, you know if you if you think of more great ideas put them over here, right? Those are some of the things I wish we thought of it at the moment, some of our basics and principles right and so that communication breakdown was visible every single day as we're like oh crumbs yep that didn't get communicated to you let's let me keep get you up to speed, so that way we don't stumble over the same stumbling blocks, we did yesterday kind of a thing, so I would say to help prevent some of those communication barriers absolutely making any of those kind of quick and easy ideas visible and then, how do we include it in a huddle we eventually did institute something to this degree, it just took us a good five days before of stumbling every single morning. And before we finally got something in place to actually but to have that in the beginning, would have been would have been much better, much smoother.
Peter Mariahazy: So Pam other than them having to use paper forms what were some challenges you experienced?
Pam: I would say that was kind of the big thing is oftentimes revenue side, like everything happens, you know for the patient, while they're in house and then the revenue cycles obvious an afterthought. And being someone who has come from the revenue cycle I get that so but I think the benefit, we have an even though, like to Whitney’s point, though there were things that were missed and things that may have been changed, I think our team has a lot of grace with one another to know that we're doing this for our patients and it's really about getting them vaccinated like we care about our Community. And so we're going to do what we need to do in order to care for them, and then we will do our best to figure out how to make it because we know that it's not going to be perfect straight up. Again, I think that through all of the incident that commands that we've had from David, we have learned that it is not going to be perfect right away but that we will come together and we will problem solve and use our tools to actually make it better, and so, in the end, hopefully to produce something that others can then replicate and not have to stumble nearly as much.Peter Mariahazy: Excellent. So in retrospect, you kind of look back on you know the quick and crude right. Whitney what was the one single biggest learning that you got as this process rolled out what's The one thing that jumps out to you?
Whitney D'Aboy:I think it's really impressive how much our organization can do on a short timeline if we're given the goals and it it's amazing how people can come together and design quickly and deliver something I don't think we ever thought, like you know, five years ago that this would ever be a reality. Where our organization is used to lean, to the point where like hey let's just quick create other process map this let's make a visual right, so I think it's just it's my biggest learning is just how great it is that we can, if we challenge ourselves if we push ourselves, we can actually do so much in such a short amount of time and it's such a great outcome for the Community.Peter Mariahazy: You know that sounds like it's a real testament to culture right the culture, the organization lays the foundation, and then, whatever the world throws at you, you guys are together to handle it so Pam what's the single biggest learning for you?
Pam: We talked a lot about the HIC structure, I would say the way we do our hospital and saying command structure may look a little bit different because it is kind of a standardized thing, but our lean principles have allowed leaders to kind of make things their own so like the planning lead planning section team can those teams can actually develop and build things that are important for that team what is that visibility and so, though, though we give structure oftentimes we use our lean thinking to make it work with and I think that's one of the things that was an Aha moment for me, in in this last year. and just working a lot more with incident command is how much we to your to Whitney’s point how much we can do when we actually come together and use our thinking and that kind of structure of like you know, making things visible walking the processes going and seeing you know, creating visual management and standard work around things like we do it very quickly. And so, how do we now, though, we can do something as big as this, how do we know why this organization and I think that there's some great learnings that we can do from this, as we continue to grow our own culture and I know for sure.
Peter Mariahazy: That's a that's a wonderful observation, so you know Whitney you get a phone call from somebody across the country what advice, do you give them who's still developing their vaccine process.
Whitney D'Aboy: I would say don't overthink it. Just try something start with something and start running and seeing where it goes, if you start overthinking it you think of again all those What if scenarios, and you're spending too much time designing and you're not getting vaccines and arms right that's the ultimate goal So how do you do that as quickly as possible, so if you if you're overthinking it and you're slowing yourself down and just you need to start with something and just start running.
Peter Mariahazy: Ties to Pam's keep it simple right just you know progress over you know paralysis so Pam whitney's just finished giving that advice transfers the person to you, what do you say to them to give them advice?
Pam: A first Whitney’s advice is great so definitely take that into consideration. It's about continuous improvement, right? And I think at this point, a lot of healthcare organizations, you are doing, vaccines within your own walls so how do you now take it a little bit further and challenge yourself, again we took a big challenge we were like 2000 a day. It doesn't have to be that big I think we can probably move this needle quite a bit, even if we're doing smaller challenges. But if most healthcare organizations are just kind of taking that leap to say how can they, how can they now support their community and the people out there that they're caring for. Just a little bit take what you've learned and improve on it a little bit and, over time, we will have everyone vaccinated you know, in a short order so great.
Peter Mariahazy: So, as we kind of start winding down Whitney any final thoughts, you want to share with our listeners?
Whitney D'Aboy: Um I would say, this is a great opportunity to start thinking about so we've been open and operational for about three weeks now, a little over three weeks and so now we're in the head we start handling second doses and more people right, so we are accepting 2000 plus up to 3001 day people. So now we're still anticipating 2000 people coming through last the 3,000second doses So how do we now have a scalable model that can get up to five 6000 doses a day. And so really thinking through what's that scalability I know Pam has been talking a lot about ratios right how many registrar's to how many vaccinators. So really kind of stretching our thinking in that way, as well as. What does snl of this look like right we can't have our HIC structure and every single lean team Member out there every day for the next nine months or however long it might take until everybody in our state is vaccinated. So that's where we really had to start thinking of the permanence who is truly going to be that operational director over some of this work, and you now have kind of spiders out to different clinics and things like that So who is the ultimate kind of person over this now that we're sending data structure. And in our incident command and then who are those kind of interim and all of this has to be interim because we're not gonna have a vaccine clinic up five years from now, I hope, and so, who can we kind of start putting in place and really start to create that structure where there is a hierarchy where decisions and they can get more of the sustain and operate, huddles going more efficiently, quick and easy words, how do we create more? Strategically that visual management board right we're using our key metrics and how we're doing each day. And so that's where our next kind of focus is going, is how do we handle first and second dose is flowing through our clinics and as well as how do we start getting more of that snl structure so that way, the rest of us can try and start getting back to some of our other responsibilities.
Peter Mariahazy: Thank you Pam any final thoughts, you want to share with the audience?
Pam: Um I would say, you know for us we've had some barriers with you know, lack of vaccines so I see that that's probably going to be something you know with bigger structures, like that so don't be surprised if some of those things happen so you know we have we were flexing our model. As we go and so keeping those things in mind and then again for us, yes, like the incident command structure pulls a lot of our leaders so most of our executive team is involved in a rotation actually all the executive teams involved in a rotation, as well as our all of our directors. And so, you know that is pulling from operations so it's very important for us to now that we've got this running and know that we've got a process, how does this become its own operations, and then we can now focus back on regular operations and the clinic has its own leadership and sustainment moving forward.Peter Mariahazy: That's excellent. That's a great way to kind of close it out, so thank you both for joining us today. And really appreciate you sharing the work on the COVID-19 vaccine clinic at Salem health.
For our listeners, please visit our code 19 resource page at create value.org to find more information and learning about navigating around the code 19 pandemic.
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