Hospitals nationwide are struggling to set up vaccination sites in the absence of any "one size fits all" solution. Writing for the Harvard Business Review, Lucy Xenophon, chief transformation officer at Mount Sinai Morningside, details the five steps her hospital used—and any hospital can use—to design and implement an efficient vaccination site.

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The 5 steps to setting up an efficient Covid-19 vaccine site

According to Xenophon, these five steps were critical to Mount Sinai Morningside's approach.

1. Define the challenge

According to Xenophon, Mount Sinai Morningside first defined the problem it needed to solve. "Our journey to create and operationalize a vaccination pod began with the problem statement: We need to vaccinate X number of people per day in Y location with Z resources."

2. Gather data and understand where things stand

Next, Mount Sinai Morningside collected "as many facts as were available," Xenophon writes, in order to understand where things stood. According to Xenophon, this information included the delivery route of the vaccines, the storage capability of the hospital's pharmacy, the number of people trained to operate the site, the number of doses expected to be made from each vial, the number of pharmacists available to reconstitute the drug, and the estimated shelf life of a reconstituted vaccine.

Based on the data, Mount Sinai Morningside determined that it would locate its vaccine pod in the facility's auditorium. The hospital then began exploring what the vaccination process might look like by adopting a "simulation mindset … and considering possible options in the space where those processes would be implemented."

3. Map out the process

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Mount Sinai Morningside then brought in a multidisciplinary team to map out the vaccination process, identifying the roles needed and detailing the steps each role would be responsible for, Xenophon writes. The organization defined the start of the process as "vaccine arrives at the loading dock" and the end of it as "patient completes recovery time," and then color-coded the functions of each role so everyone could easily see where each fit into the process.

In another exercise, the team outlined a process map for the pharmacy team, enabling the team to define their roles, outline any potential obstacles, and develop an efficient storage and preparation plan for the vaccine, Xenophon writes.

4. Determine what the standard work is

According to Xenophon, the team then wrote up so-called standard work—"the steps that must be taken in order to complete a process in the best-known way"—for several roles in the process. This work is "written by the people who do the work, socialized to all who do the work, and is meant to change when an improvement to the process is made."

For example, Mount Sinai Morningside defined standard work for the pod manager, who oversees all activity in the pods. That person's work, they determined, should include performing team huddles, counting the vaccines, ordering vaccines based on an anticipated schedule, and collecting data on how many vaccines are administered. Meanwhile, the pharmacist "receives, stores, prepares, and delivers vaccine, and coordinates the number of doses to prepare with the pod manager," and the staff coordinator "manages the daily schedules to fill the pod roles."

The organization also determined that a physician, physician's assistant, or nurse practitioner should be available in the pod at all times to respond to any medical emergencies or field questions.

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For each role that Mount Sinai Morningside defined, multiple dress rehearsals were performed, Xenophon writes, which helped everyone understand the process better and revealed potential obstacles and challenges, ultimately leading to a smoother process and a more confident staff.

5. Make adjustments to execution based on simulations

As a result of multiple pod simulations, the team developed several different design iterations, Xenophon writes.

For example, the potential problem of patient privacy was addressed by making sure privacy screens could accommodate a chair for the patient, a laptop on wheels, and a table for supplies. The team also made sure at least one bay was large enough for bariatric patients or those in a wheelchair.

Mount Sinai Morningside also ensured each bay had standard supplies and a printed set-up diagram, making it easier for those on duty to assemble the bay, Xenophon writes.

To minimize batching vaccines—so as to avoid wasting any that are prepared and not used by the end of the day—Xenophon writes the team continually checks how many patients are left on the schedule against pharmacy orders for vaccines, ensuring the pod manager and pharmacy manager communicate throughout the day to adjust for no-shows and review how many patients are left.

"The enormity of the task [of vaccinating the population], based on both demand and urgency, leaves little room for error," Xenophon writes. "A basic continuous improvement infrastructure provides excellent tools and strategies to quickly design and scale vaccination pods that can be customized to location, size, and available resources" (Xenophon, Harvard Business Review, 3/12).