February 8, 2021

Vaccinating the globe: The ultimate systemness challenge

Daily Briefing

    The rollout of Covid-19 vaccines has been difficult in the United States and abroad, with many different countries facing common obstacles. In this episode of Radio Advisory, host Rachel Woods sits down with Advisory Board's Brandi Greenberg and Paul Trigonoplos to discuss the challenges countries are facing in their vaccine rollouts—and how health leaders can take a more active role in addressing some of these issues.

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    Read a lightly edited excerpt of the interview below. Then, download the episode to hear the full conversation.

    Rachel Woods: Beyond supply, one of the big challenges we're feeling here in the United States with the vaccine rollout is that even when vaccine doses are available, some folks just are choosing not to get it. And I think that's happening at higher rates than we would have initially anticipated. Is that something we're also seeing on the global stage?

    Paul Trigonoplos: Yeah. So, there's skepticism and apprehension across the board internationally. And if you look at the data, and I know that this data is something that you have to put a lot of salt on right now, because the willingness to get vaccinated changes so quickly. But the initial data from December 2020 and January of this year does show at least 10% to 40%, depending on where you are, of people do not plan on getting it anytime soon.

    And I will also say that skepticism is only one of the downstream factors that is kind of limiting uptake, especially in the European Union. Lack of capacity in the local system, lack of supply in terms of staff, in terms of needles—Greece and Italy, for instance, are running out of needles. You have kind of chaotic scheduling systems, decentralized scheduling systems, that make it pretty hard to get an appointment, and then add on that skepticism from clinicians, skepticism from patients, the downstream problems you see in the United States are happening everywhere else.

    Woods: And that brings us to what we need to do about it. I think it's safe to say that no one in the world has solved the vaccine rollout problem. At least, not in a way that the rest of the world can actually replicate. So let's talk about how organizations can actually solve some of these systemic challenges.

    I want to start with just how confusing this moment actually is for all of us, whether we are working in health care, or are outside of it. How do leaders actually help in navigating the mass confusion that consumers are feeling?

    Brandi Greenberg: I'm so glad you brought this point up, because in the last two weeks, outside of my work at Advisory Board, I have felt this sense of confusion viscerally, in navigating not only my parents' own vaccine experience, but my mother-in-law's, and two family friends.

    Three different states, three completely different experiences. And what it brought to light for me was this sense of confusion, and the opportunity that a coordinated health system, or a coordinated medical group, has to fill the void with clarity.

    I don't know if it's as simple as old-school patient journey mapping, or root cause analysis, but simply stepping back and thinking about the patient experience and the questions they need to ask. When is it my turn? Who's going to tell me? Where am I likely to get it? How will I know that it's safe for me to go there? Those are completely answerable questions by most health systems or medical leaders.

    Woods: They're also not new questions. Let's not pretend that health care was a simple experience prior to this crisis. And so in theory, leaders should have practice being able to answer some of these complex questions when they look at a patient journey. And I get frustrated when I don't see that happening.

    Greenberg: And I think you bring up a huge point, which is why the analogy that I've used. It feels like I'm watching a Three Stooges movie where there's a little bit of he did it, no, he did it.

    The right hand doesn't know what the left hand is doing. And that is where all of that effort at systemness, at integration, at the level of communication and outreach, all that work that you have done for years as a provider organization to reach physicians, to reach consumers, it's the same skillset.

    And even in answers where you don't know, a simple, "We don't know yet, but here's what we're doing to find out. And here's how you will be updated when we know," that stuff can go such a long way.

    My fear is that too many providers are ceding, they're abdicating their role as communicators, simply because the government is purchasing, and the government is managing so much of the logistics. They need to own the communication space.

    Woods: Paul, what are other health systems in other countries doing to combat this confusion?

    Trigonoplos: First and foremost, they're making it easy to sign up. And there's kind of a couple anecdotes I can share here.

    On one end of the spectrum, you have the National Health Service in England, which is a national system. They have a single, central booking system. So in NHS, right now, you get a letter in the mail that invites you to sign up through the system, and that's their way of kind of controlling demand. So you can sign up only after you get a letter. It sounds kind of archaic, but in reality, most of the people getting vaccinated right now are over 80 years old. So I think they're more familiar with this kind of written approach.

    The other end of the spectrum, you have Israel, which is a totally paperless booking system, text and app-based. And even in between, France is lagging, but they are starting to turn things around a little bit. They actually are landing on three private wellness and primary care providers, which are already really good at the booking process, to handle the countries booking systems.

    So now, there's three that it is clear from the public's perspective, "Okay. I go to one of them, and I book it through there." This kind of simplicity is going a long, long way.

    Woods: I appreciate that you said that the answers that are out there are simple, because I will admit, my frustration is that there's this missed opportunity, I feel, to actually be the guiding force in the market.

    Even in these simple ways, even if it is literally sending a letter, or leaning on other partners in the market. Brandi, you and I have talked about this, literally, four times on this podcast, that the scientific innovation, as incredible as it was, was really the first step. And it's hard, because nobody gets a Nobel Prize for the right scheduling software, but that's really the role that health care needs to be playing right now.

    Greenberg: And I'd go one step further, which is that not only are they missing the opportunity, I'm actually hearing stories of messed-up opportunities. So, at a moment when you could delight, you are actually disappointing.

    And that is the worst of all possible worlds here, where you have an opportunity to engage patients in new ways, to outreach to new consumers, and that front door experience of communications scheduling, coordination, matters so much. In the, "I don't have any information, come back later." Or when people are searching for vaccine scheduling, and it's like they get an "under construction" link on your website, I've heard.

    Those are moments that, far worse than a missed opportunity, they may never come back.

    Woods: So then in your opinion, I guess to both of you, when it comes to systemizing information that combats this confusion, is there one kind of easy thing that leaders in health care can be doing right now?

    Trigonoplos: I have one thing that systems are doing. I don't know how easy it is, but I think it is something that I would put forward as a need-to-have, which is, I think to Brandi's point earlier around systemness. One of the hallmarks of systemness is having very clear governance. Who does what? Who is responsible for making which decisions? Which roles are assumed by which people? And in other countries, I think you have a lot more clarity, and it's kind of set from the top.

    The pharmacists are the vaccinators, the primary care practices are the ones who organize the letters to notify people when they need to get a vaccine, and so forth down the line. We actually saw this in West Virginia too, when they kind of made this bottom up network of pharmacists, that basically said, "Okay. Pharmacists are going to lead the charge, at least for the long-term care homes, they're the vaccinators. Let's rally around them." And I think just adding a level of simplicity over, who's making a decision?

    Whose job is it in your geography? Whose job is it not in your geography? And just telling people that is probably a good place to start, because I think the chaos at the ground level is a symptom of that, not the root cause.

    Greenberg: Bringing it back to my parents' experience, they went from the overwhelmed moment when the pharmacist told them to call the primary care doctor, the primary care doctor told them to call the hospital, and the hospital told them to call the pharmacy. A week later, it was from their county public health service, but it laid out, "This is the timeline. This is who is going to call you. This is how your appointment's going to work."

    This is where you will get it. Their blood pressure dropped immediately on that particular communication, on the who, the how, the when. Immediate difference.

    Woods: I love that story, but Brandi, you're not going to get out of answering this question. Do you have maybe a slightly different take on kind of an easy thing, especially if Paul's answer wasn't actually easy, that leaders can be doing to combat this confusion?

    Greenberg: Yeah. I think for them, what I would say the easiest thing to do, is also to go back to core competencies. And within that same rubric of who's doing what, pick one thing that they're going to centralize.

    From that systemness perspective, is it, we're going to make sure that the digital front door, anybody that goes to our website, anybody that uses our mobile app, every single facility, every single physician, this is going to be the language that they're going to use, and a centralized webpage.

    Woods: And again, we proved that we could do that once, in March and April. So I get frustrated when I go to health system websites, and the banner at the top is unchanged.

    Greenberg: Right. But, just to add onto that, there are other systems where I've seen they have these incredibly elegant, easy-to-use, centralized scheduling systems, app-based. One in the Midwest, I know, was how my sisters-in-laws got a vaccine. So if that's your strength, run at it, pick that thing, and say, "We're going to centralize scheduling."

    Because that can also help them look for partners. And so, that's the other thing where they can start to focus is, as much as systemness important, systemness doesn't mean you have to do it all yourself.

    Woods: That's right. And that's where we see examples of exemplars, like Zocdoc, jumping in and saying, "We will do scheduling for you, for your clinicians, or for your community, when it comes to getting this vaccine."

    Greenberg: Or even in West Virginia, where they realized that the most important thing to vaccinate their seniors in long-term care facilities, was actually skipping the mass pharmacies, and contracting with a bunch of local mom and pops in rural areas. That was the partnership that seems to be working for that state.

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