24 100,000 reasons QI works: a vaccine story

Background In late 2020, in the midst of a surge of COVID-19 in Minnesota, the Pfizer/BioNTech vaccine was granted emergency use authorization. HealthPartners CEO Andrea Walsh challenged our organization to provide a plan for administering 10,000 COVID-19 vaccines a day, and Park Nicollet Methodist Hospital leveraged our history of quality improvement to rapidly plan, execute, and scale vaccine administration. Objectives Timely vaccination of multiple populations (healthcare workers, high-risk patient populations, and general public) Operate efficiently under several constraints (space, staffing, and vaccine supply) Maximize capacity to fluctuating vaccine allotments Methods Our work leveraged several QI tools such as value stream mapping (figure 1), weighted average cycle times (figures 2 and 3), visual management (figure 4), and standard work. We utilized the Model for Improvement and sequential PDSA cycles (figure 5): Space required ongoing adjustments in roles, staffing, and flow. We cross-trained to allow for multi-skilled operation, and to accommodate social distancing through the entire process. To reflect our community’s needs, we continuously adjusted to provide a mixed model of first/second dose, delivering service in multiple languages, serving adult and pediatric populations, and ambulatory and non-ambulatory patients. We used predictive modeling to anticipate number of vials needed, standardized drawing process to maximize doses from each vial, and instituted a standby process to eliminate end-of–day waste. Results In total, during a 6-month operation we administered nearly 100,000 doses. Conclusions Our legacy as an organization with a mature culture of improvement contributed to trust of rapid cycles of PDSA, which allowed us to deliver on the Triple Aim: Reducing cost by using existing employees and volunteers Addressing health of the population by targeting multiple patient tiers to optimize supply Delivering experience from invite to injection with sensitivity to patient needs