South West AHSN report executive summary
In January 2021, Devon STP approached the South West AHSN seeking support to optimise the operation of six PCN-run COVID-19 vaccination centres.
The South West AHSN embarked on a rapid four-week insight gathering project geared towards improving processes, maximising the use of resources and, ultimately, increasing the number of patients receiving a vaccine at each site.
After building an understanding of the processes, the South West AHSN utilised its past learning, knowledge-sharing networks and modelling expertise to produce a series of conclusions and proposals.
The vaccination sites have started to show a significant increase in patient throughput and, with second vaccines due to be rolled out shortly, this learning will prove invaluable in the time ahead.
This summary has been produced to communicate key findings of this work, the full details of which are included in the main report.
Mapping and modelling
The South West AHSN’s work focused on six PCN vaccination centres – Barnstaple Leisure Centre (three PCNs); Crediton Leisure Centre (one PCN); Exmouth Tennis Centre (three PCNs); Newton Abbott Sherborne House (two PCNs); Plymouth Pavilions (four PCNs); Torquay Riviera Centre (three PCNs).
Each site was visited over three weeks to map, time, observe and understand key learning points. Time was also spent analysing the University Hospitals Plymouth hub to gain further insight to inform the PCN optimisation programme.
At least 10 patients were observed going through the process, with the time spent at each stage of the process recorded. This process comprised arrival and check-in, consent and mental capacity, clinical review, delivery of vaccine, post-vaccination observation.
The process mapping data was then used to develop a simulation model that could be used at site level to predict the potential impact of workforce and process changes. The overall aim was to reduce queuing (waiting) time and maximise the use of available resources.
Simulation modelling has demonstrated how vaccination centre operational teams can explore changing variables to improve resource efficiency– i.e. arrival time, service time, resource (staff and physical space) indicating how this might affect queuing time and resource use.
The simulation technique allows the operational teams to adopt a ‘trial and error’ technique without any consequences and is a useful tool to use to drive site operational improvement.
Gathering and sharing best practice
Another key facet of the South West AHSN support was that learning could be gathered, at speed, from parallel programmes that were being run around the country.
The organisation used its extensive networks to tap into knowledge gained from various programmes, including:
- NHS Gloucestershire’s COVID-19 vaccination programme
- Health Innovation Manchester’s mass vaccination flu clinics
- Health Innovation Network South London’s study on vaccine hesitancy COVID-19 vaccination
- Humber Coast and Vale ICS’s digital roll out of COVID-19 vaccination programme.
This research produced numerous insights that were incorporated into the Devon STP’s optimisation programme. These were among the key findings:
- NHS Gloucestershire CCG suggested what ‘good’ might look like, highlighting that its vaccination centres deliver up to 1,200 vaccines a day.
- Clinical Directors and key CCG figures used WhatsApp groups to provide rapid responses and share learning.
- Consistent use of vaccine booking system accuBook greatly aided the process, significantly cutting down on DNA (patient non-attendance). Subsequent learning has shown the benefits of using QR Codes to speed up data entry on Pinnacle.
- The first communication to the patient is most important and is the best opportunity to convert into a successful booking (and reduce waste of resource). The call to action needs to be clear and the patient needs to be able to book from the web link in the SMS.
- Use of the Vaximap online tool to plot housebound patient journey times, saving time in both journey planning and delivery.
- Navigator tools that present vaccine information in a straightforward way on a platform familiar to the target audience greatly reduces vaccine hesitancy.
Workforce and knowledge spread
Workforce was identified as one of three factors that affected the efficiency of vaccination centres – alongside vaccine supply and patient flow.
With this in mind, the South West AHSN – with agreement from key stakeholders – focused on workforce as the most readily influenceable element of the programme.
As part of these efforts, the team worked with CCG stakeholders to confirm and share workforce planning assumptions and mitigations, and supported the mobilisation of a workforce ‘cell’, which meets daily.
The cell stakeholders have now been identified as potential ‘champions’ of PCN optimisation and should be engaged for further work with any of the PCN sites, either by locality groups or individually.
The South West AHSN is also working with the primary care leads to spread learning related to its modelling activity and has responded to expressions of interest from the NHS England and NHS Improvement about Devon’s work and approach.
Harnessing past learning
When the COVID-19 pandemic hit the UK, the South West AHSN carried out an extensive analysis of how the health and care sector in the region was responding to the crisis.
The aim was to use this learning as a blueprint to help the sector react quicker to change and become more resilient in the future.
The study, which drew together around 300 contributions, found that there are eight ‘conditions’ that most frequently facilitated rapid change during lockdown – six of which were identified as relevant to the Devon vaccination optimisation programme.
These were:
- Adaptability – to enable a culture of continuous learning and improvement within the sites
- Partnership working – with local voluntary sector to outsource volunteer supply to delivery sites
- Shared purpose – across the system and amongst all parts of the team and outside organisations involved in site delivery
- Permission (psychological safety) – for staff at all levels to contribute to process and campaign
- Removal of organisational and system barriers – across practices, PCNs and local voluntary sector organisations
- Communications – across the system and at pace to enable rapid issue resolution, mitigation and sharing of lessons learned.
Looking ahead
The South West AHSN has shared the findings of the optimisation programme with a range of Devon stakeholders, and other vaccination stakeholders and centres in the region, and beyond.
It plans to schedule four learning sessions in March for North, East, West and South-based Devon PCN groups, which will focus on three key themes – patient experience and safety, process efficiency and workforce sustainability.
There are also plans to build on this learning by testing models with other centres to find out how they can be used to drive improvements and innovation.
Read the full report
If you’d like to read the full report or find out more about the vaccination centre optimisation programme, please contact Stuart Monk, Programme Director at South West AHSN: stuart.monk@swahsn.com