Health Service Executive (HSE) 

Vaccines Distribution Service for GPs & Pharmacies - NON ICT

Health Service Executive (HSE) 

Vaccines Distribution Service for GPs & Pharmacies - NON ICT

BACKGROUND

In early 2020 when the Covid-19 pandemic reached Ireland, the Health Service Executive (HSE) was asked to respond urgently to a challenge containing many elements they had no prior experience of, including establishing and running nationally integrated call centres, integrating SMS, web and app channels, logistics organisation to vaccinate our population, building out the needed computer systems (none of which existed before the pandemic), redeploying senior and junior staff into roles they had never played before, and establishing a permanent enduring infectious diseases protection organisation to bring us through the pandemic, and its aftermath.

Since the outset of the pandemic VISION has been in situ at the HSE helping them to navigate through the multiple challenges presented in their response to Covid-19.

The HSE’s vaccine roll out programme relies heavily on GPs and – from late June (2021) - pharmacists administering the doses. As an initial step the HSE had established the vaccine roll out programme with a small vanguard of GPs, and a simplified approach to start distributing vaccines quickly, given the urgency of the situation.  

CHALLENGES & OPPORTUNITIES 

To successfully deliver the programme the HSE needed to have clear and accurate coordination between the storage companies and the GPs and pharmacists. 

This was a high-profile project with a significant level of daily media attention. In the early days particularly, the GPs were publicly very vocal and demanding about the service quality.

It became clear very quickly that to effectively scale the GP vaccination programme nationally, the HSE would need to rapidly assemble an expert team that could support the vaccine roll out programme.  

VISION APPROACH

To scale the vaccination programme quickly the HSE required a partner to:

SERVICE DELIVERY 

Diagnosis

VISION carried out an immediate diagnosis and identified the key challenge was improving GP confidence in the service and dealing with the hundreds of daily phone calls and emails efficiently and effectively.

The diagnosis uncovered the following issues that had to be rapidly resolved:   

1. The Pfizer vaccine used for distribution to over 90% of GPs had to be used within four days of being loaded onto the delivery van. This gave GPs a limited window to organise clinics and administer to patients and gave us a limited window to redirect the vaccine in the event of a problem arising.

2. The team was working in an environment that changed - sometimes drastically - on a week-to-week basis. The team needed to be resilient and agile to respond at pace to changes in the supply, changes in medical and pharmaceutical guidelines, IT environment, political concerns, changes in the requirements of individual GPs, and so on. 

3. There was very little high-quality data easily available which makes automating the equitable distribution of the vaccine very difficult. To address this lack, the team supplements the existing data through regular conversation with individual GPs and pharmacists to fully understand where the vaccine ought to go and in what quantities.

4. Distributing the vaccine requires coordination across a wide array of working groups: HSE leadership, vaccine supply chain, a data team, a drug order processing team, the cold chain logistics service, the vaccine cards and leaflets delivery service, the consumables (e.g. syringes) delivery service, and the GPs themselves along with their representative groups. When breakdowns do occur in any of these areas the team is required to produce immediate workarounds to avoid a loss of vaccine or disruption in the supply chain.

5. The GP vaccination effort, because of its significance to the national vaccination rollout, was subject to intense political and media scrutiny.

Solution Design

VISION designed a solution based around the GPs experience as a customer of the HSE’s vaccine programme. The team made simple, clear commitments to customers about delivery dates and vaccine volumes that GPs began to rely on, thereby reducing repeat communication.

The core elements of the design were:

Implementation

The GP vaccine programme started in February 2021 and the pharmacy programme in June 2021.

VISION redesigned and mobilised the Vaccine Delivery Service for GPs within two weeks of being appointed. This included hiring and training a team, developing technology from scratch to support the delivery process and the related conversations with GPs, managing the complex coordination across the supply chain, and developing the initial approach to the equitable allocation of vaccines. 

VISION established a 20-person team led and managed by VISION and made up of external contractors that has since grown to approximately 30 people. Within two weeks of starting we had the team up and running and within a month we had the core management and coordination structures in place. 

To cover all aspects of the GP and pharmacist vaccination programme we organised the 30-person GP Vaccine Team into four main areas of work, as follows:

OUTCOMES

The team, which was assembled from disparate organisations with very different cultures, integrated quickly, and continues to work very effectively together.  

This case study specifically highlights our work mobilising and coordinating the GP Vaccines Team, which is responsible for vaccine rollout through local GPs and pharmacies throughout Ireland.  This work is ongoing.

CONTRACT MANAGEMENT 

Day to Day Governance

VISION managed the team using two daily huddles along with a set of key performance indicators, which includes an assessment of the mood and morale of our customers - the GPs and Pharmacists.

Relationship Managers & The GP Vaccine Support Team

VISION established and trained a team of Relationship Managers (RMs) to serve as the voice of GPs and Pharmacies in the Vaccine Rollout Program. We charged the team with providing a top-class level of customer service to their practices. At its most basic, this meant making sure GPs and Pharmacies were adequately prepared for their deliveries; surprises were to be removed from the process. 

Every GP/Pharmacy would receive a call from an RM a week in advance of their delivery to notify them of their delivery. Often, the VISION team found that the originally allocated amount was not suitable – the GP had patients we hadn’t accounted for, or had staff on holidays, or was helping to vaccinate another practice’s patients, etc. In addition to outbound calls, each GP would have an email and contact number for their RM; they could contact their RM at any time and expect a response within 24 hours.

Empowering RMs to represent GPs and Pharmacies 

VISION established a practice called the Change Request Meeting which was attended by all RMs. Here, RMs would bring their GPs/Pharmacy requests to a manager who had sight of the available vaccine supply and would assess, approve or decline their change requests. We developed a basic ruleset to inform these decisions, but we also allowed for some flexibility in the process. 

VISION trained RMs how to assess the mood of GPs/Pharmacies  on their calls and use that to inform their requests; they knew which GPs/Pharmacies were particularly panicked, desperate, or irritated, and that representation played a role in our decision-making. In return for this flexibility, we required RMs to ensure GPs/Pharmacies were not left wondering about the state of their request. VISIONS management team demanded that the RMs make and deliver on commitments to GPs/Pharmacies  and were rigid in enforcing that.

Two-Way Communication with GPs and Pharmacies 

Outbound email updates played a large role in keeping GPs/Pharmacies up to date through the duration of the program. RMs received briefings on all of these updates and incorporated them into their calls to GPs/Pharmacies, clarifying any ambiguity or queries where necessary. RMs also represented the concerns of GPs/Pharmacy back to the VISION management team – they let the team know what GPs/Pharmacy were most concerned about, and that in turn informed the content of the next communication to GPs/Pharmacies.

Supporting IT Software

VISION built a CRM system from scratch on Google Sheets. The RMs use this to record their conversations with GPs, submit change requests, and view previous and future deliveries. This platform was also utilised for monitoring the mood of the customers and for performance management and recognition of the RMs 

Coordinating the End-to-End

3-2-1 Meetings 

VISION established and lead a weekly Rolling Planning Meeting this brought the HSE and the multiple suppliers together to coordinate around deliveries up to 3 weeks in advance; this  helped the team identify problems early, understand the constraints of supply and to reduce waste. 

Resolver Meetings 

VISION established a daily ‘Resolver’ meeting with HSE Primary Care  for and on behalf of GPs and once Pharmacies joined the program this meeting also included Community Care 

This meeting was to escalate urgent issues and concerns and to keep them informed of the progress of the program generally.

CONTRACT PERFORMANCE

The HSE recognises VISION as both a partner and an operational mobiliser – i.e. VISION have the skills and ability to interpret the challenge, design coherent practices to overcome it and the expertise to mobilise the teams to deliver the required actions.

VISIONs RMs managed on average 100 GPs or Pharmacies each as their base and this enabled the RMs; to cultivate a relationship of trust with their practices. This has allowed us to anticipate emerging problems and reconfigure the deliveries quickly to keep things on track, without creating breakdowns for the practices.

As of the 14th February 2022 , the GP Vaccines Team has done the following: 

• Coordinated the distribution of approximately 4.3 million vaccine doses to 1,100 GPs and 900 Pharmacies throughout the program 

• They have had over 22,000 conversations with GPs and Pharmacies ensuring continuity of service and managing the mood and expectations and maintaining trust 

• Built a robust technology platform that provides control and governance of the end-to-end process. 

• Ireland has had one of the most successful vaccine rollouts in the world – GPs/Pharmacies have played a significant role in this.