Welcome to "Field Report," a series where Advisory Board experts share what they’re hearing from health care organizations across the country. In this edition, Advisory Board's Susan McDonald interviews leaders at Henry Ford Health System about their innovative partnerships with churches and other community organizations to distribute Covid-19 vaccines.
The responses below are edited answers from an interview with Susan Hawkins, Senior Vice President, Population Health; Zain Ismail, Principal Management Engineer; Logan Bryer, Administrative Fellow; and Sam Mossallam, MD, VP & Medical Director, International Initiatives.
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Q: What innovations have you implemented with vaccination strategy/deployment?
A: We started by vaccinating our own staff and medical workers affiliated with our system. This allowed us to pilot how we would roll this out to the broader patient base. We realized we needed to figure out how to space out appointments, determine who was qualified as observers to identify post-shot symptoms/reactions, and decide who could administer the vaccinations. We also learned how best to store and draw up individual syringes of the vaccines to avoid any wasted doses.
In January, we were vaccinating only at a few existing clinics. But by early February, we were operating five mass vaccination sites. As we expanded our reach, we found we needed to start with older patients and move in increments down to the 65-plus age group (the state guidelines at the time). We had 15,000 active patients over the age of 95—we started with them. By mid-April, following state guidelines, we are now offering the vaccine to all patients ages 16 and up.
One of the biggest challenges early on was just scheduling people. MyChart, Epic's patient portal, was a great tool for scheduling and messaging, but it didn’t reach populations with limited access to technology—and those were the people we needed to target most. We began focusing on certain ZIP codes for messaging when appointments were available. In mid-February, we started calling patients directly if they had home numbers in their records but were not registered in MyChart and had no email address or cell phone number on file.
Another innovation was establishing partnerships with the community. We came together and worked cohesively, even when we weren’t receiving many vaccines. For example, when we were all limited to only a few thousand doses a week, we shared our staff with our community partners, including local health departments, to deliver vaccines to their constituents. Within a few weeks, we were also assisting our corporate clients and physician organizations with vaccinating their essential workers through our Henry Ford @ Work program.
We also leveraged our Global Health Initiatives team, which in pre-pandemic times spent much of their time working internationally. The original intent of this group was to learn about innovations in other countries and incorporate them into our delivery system. But when the pandemic hit and the team was grounded, they quickly pivoted to help with Covid-19 testing sites and—starting in January—vaccine distribution.
Finally, we were approached in early March by FEMA, the Department of Defense, and the State of Michigan to serve as medical director and operations management at Detroit’s Ford Field, one of 12 FEMA mass vaccination sites in the United States. These organizations, as well as Meijer Pharmacy, will deliver 5,000 to 6,000 vaccines each day for eight weeks to residents of Southeast Michigan’s tri-county area.
Q: What changes are you making to your process?
We created a Vaccination System Incident Command (SIC) in early January, modeled after the COVID SIC we put in place to make rapid decisions in the face of the Covid-19 surges last year (and ramped up again this spring as we’re experiencing our third surge in Michigan). The Vaccination SIC team recruited co-commanders, specialists, and section chiefs to address areas such as federal/state/local government liaison activities, safety, pharmacy, operations, planning, logistics, staffing, patient experience, and communications. We met daily for several weeks so we could make changes in real time, then moved to our current three times per week cadence. We shared data on appointments made, vaccine supplies being shipped, and adverse events after vaccination. We could examine issues like unused vaccines and immediately respond.
In addition, we monitor the news daily, including the governor's press conferences, CDC guidelines, and new research coming out about vaccine efficacy and use. We learn what others are experiencing to incorporate those lessons into our emergency planning.
Q: What were some of the biggest challenges?
There are a lot of administrative and documentation requirements at both the state and federal level, including determining who should be first to get the vaccine. We were able to share data about our vaccination processes and protocols, including distributing the vaccine beyond our own patient base, and this advocacy helped influence the state's strategy.
An example of one particular challenge was how to vaccinate dialysis patients. We have dialysis centers where we see about 2,000 patients for their treatments three times per week. We began offering them the vaccine while they were getting treatment. This was convenient for our patients, and seeing their peers receive the vaccine made some patients feel comfortable getting it, even if they had initially declined. Similarly, we began vaccinating our Program for All-inclusive Care of the Elderly (PACE) participants here in Southeast Michigan. Since these participants visit their PACE community centers each day, we were able to vaccinate most participants at multiple sites over the course of just a few days. Interestingly, we found that seeing older participants of color receiving the vaccine influenced some of the PACE employees who had initially been hesitant. In a third example, we created a process for vaccinating homebound patients through our Home Health program at Henry Ford, which required special refrigeration units and training for the nurses on safe vaccine storage, handling, and distribution.
Q: How are you handling vaccine pushback?
We established a vaccine hesitancy and awareness team, which includes patient advisors and staff from our mobile clinics, infectious diseases, employee health, and communications to act as “myth busters.” This team meets with different groups (even our own employees) to get to the bottom of their concerns. Along with the support of faith leaders, this has had a really big impact. Trust is key. One advantage we have at Henry Ford is our strong reputation in the community.
Like other health systems, we continue to struggle to get all our staff vaccinated. Early on, when Henry Ford employees were able to receive the vaccine as “1a” populations, only about 55% were vaccinated. We’re looking into why that number was so low. For example, do all of our employees monitor their email? This was our primary way of communicating about scheduling vaccine appointments—all the way back in December, when we received our first shipments. We moved to text messages for communication with our staff, and recently distributed a survey to find out how many staff members still plan to receive the vaccine (and when) and which are not planning to (and why not). We’re also gathering data from employees who offer to share that they were vaccinated elsewhere, as well as the dates and vaccine type, so we can update our employee records.
We also focused on consumer experience and safety to address issues of access to vaccines or concerns about side effects. We hired a new staff member who is a former consumer experience expert at Disney. We wanted to make the total experience positive, from scheduling to vaccine administration. And we kept in mind that optics are important. We didn’t want pictures of people waiting outside in the cold. That might have led to reluctance, so we made sure it didn’t happen. Once the weather became less bitter cold, we began a drive-through clinic in one of our markets, using warming tents, in-car “waiting” areas, and other lessons learned from organizations in warmer climates.
Q: What lessons can you share with other organizations?
What we would say to other members is that it's complicated but possible. Do the math. Ask yourself how many doses you need today, how big is your site, how many staff do you need—then build a model based on that. These are simple questions, but they helped us. Then, repeat this math every week based on the supply of vaccines coming. We find out on Fridays what our allocation will be for the following week. We've added and subtracted sites, expanded and compressed hours, and added/reduced staff—all within a few days to adequately and completely distribute the supply we'll receive.
We would also suggest being flexible with scheduling processes over time. We moved from vaccine-constrained appointment scheduling to limited batches at a time to the direct self-scheduling process we have today (available to anyone with an existing—or newly created—medical record number). We also added check-out scheduling in our primary care offices, allowing front-desk staff to book vaccine appointments from the office based on the PCP’s recommendation during a visit. Our next process to design is ongoing booster immunizations in PCP offices, similar to our annual flu shot processes, so we can begin to ramp down our mass vaccination sites over time.
Another lesson is to treat vaccine distribution like your organizations treated Covid-19 case surges, hospitalizations, and supply shortages in 2020. Make decisions quickly, update the policies on delegating authority to be able to flex when necessary. It takes a village. No one department or community can do it alone; you need to pull resources from everywhere.
Trust and empower each other. We needed a lot of players at the table, and we needed to trust in each other. This was vital. From our SIC staff to our frontline clinical workers to our supply chain, it took everyone.
Q: What has been your greatest success so far (big or small)?
Our greatest success was the community we built as part of this experience. Don't forget even in hard times, remember to laugh. Make your organization a place people are proud of, where they want to come to work. We recognize it's challenging and even sad sometimes, but try to make it fun. Our incident command turned into a lasting relationship with our peers.