COVID Vaccination Program

[00:00:00] Roberto J. Arbulu: Before we introduce our next speaker, I want to bring to your attention that back in January, 2021, earlier this year, PPI published an article as part of the PPI thinking on how to accelerate the deployment of COVID-19 vaccines, an operation science perspective, and the article proposed a variety of actions

[00:00:27] Roberto J. Arbulu: for those in the government, for those involved in, you know, COVID-19 vaccines. And the reason why we bring this up is because our next speaker is going to touch on this, and he has actually been able to implement some of the recommendations that this article published by PPI proposed. That being said, I would like to welcome Randy Kelley.

[00:01:02] Roberto J. Arbulu: So Randy, if you can please share your video and I want to make sure that we can hear you as well. Can you hear me, Randy?

[00:01:10] Randy Kelley: Yes, I can hear you fine. How about me? So, can you hear me now?

[00:01:15] Roberto J. Arbulu: Yes. Great. So we are going to, Randy, thank you for joining. Welcome to the Symposium and we really look forward to hearing your story.

[00:01:29] Roberto J. Arbulu: And it’s going to be about an estate-level COVID vaccination program. And so, but please allow me to introduce Randy formally and say more about you. Randy has recently led operations on multiple mass vaccination sites throughout North Carolina, the lack of fundamental operations knowledge in government and private sector.

[00:01:53] Roberto J. Arbulu: Healthcare provided Randy the chance to implement operation science to that process with the speedy adoption of these principles. The result of the turnaround had profound results in customers served, increased throughput, and much higher revenues for those involved. Prior to that, Randy worked on the largest construction project in the world, providing technical support based on operations and supply change science to several project teams.

[00:02:22] Roberto J. Arbulu: Randy has spent 11 years as a U.S. Navy SEAL sniper with combat tours in Iraq and other hotspots. In 2005, he founded Red Tail Corporation, a specialized defense company, and provided training and surveillance equipment to U.S. and international special operations units. As CEO he built the company to over $6 million in revenue by 2010 and then started seven other companies, which he then proceeded to sell before moving to other ventures.

[00:02:55] Roberto J. Arbulu: Randy has an MBA in Global Management from Thunderbird School of Global Management. Randy, once again, thanks for being with us. And let me stop sharing my screen so it will be over to you.

[00:03:11] Randy Kelley: Okay. Screen

[00:03:20] Roberto J. Arbulu: Everything okay? Everything okay?

[00:03:27] Randy Kelley: No, you’re still, I think you still have control over the screen.

[00:03:35] Roberto J. Arbulu: Okay, let me, let me see if I can solve that problem here. Excuse me.

[00:03:44] Roberto J. Arbulu: Okay. Please go ahead. There we go. Yeah. Thank you.

[00:03:49] Randy Kelley: No worries. All right.

[00:03:57] Randy Kelley: Okay, so you just see the regular view. Right. Okay. Thank you very much, Roberto, for the introduction. Thank you all very much for the chance to speak at this symposium. It’s good to see you all again and I’m pretty excited to share this case study that I actually worked on.

[00:04:22] Randy Kelley: You’ll see almost all these pictures I took while I was on site, so I’ll just let a lot of the pictures do the talking and I’ll just fill in some of the details. So let’s start with this. I’m currently working on special projects for the U.S. Navy, but earlier this year I had the chance to uh, I had a chance to provide operations consulting companies providing COVID-19 vaccines throughout the state of North Carolina.

[00:04:54] Randy Kelley: I’d like to share how the principles of operation science worked in that turnaround. So, first of all, I went to North Carolina in April of this year, and this was just before president Biden opened up all the COVID DS to those over age 16. Before then, it was only for a high risk person, people.

[00:05:23] Randy Kelley: But we’re about to open this up for all U.S. citizens throughout the country, before North Carolina, that meant a population of about 8 million adults.

[00:05:36] Randy Kelley: To meet this demand, Pfizer, Moderna and Johnson & Johnson all shipped their vaccines directly to the North Carolina Department of Health and Human Services. Those two facilities were in Charlotte and Raleigh, North Carolina. And they were stored in these ultra cold freezers that uh, you see here, bring a temperature way down.

[00:06:00] Randy Kelley: So as full vaccination approval spread across the country, mass vaccination sites quickly opened up in Charlotte and Raleigh right next to those freezers. They were also the two most populous cities in North Carolina. You see Charlotte and Raleigh right here. Demand was so great, however, that we saw major traffic jams at these two sites for days on end.

[00:06:21] Randy Kelley: This frustrated healthcare workers and those wanting the shots. These pictures are of Bojangles Coliseum. They’re in Charlotte. Many of these people were turned away. Vaccines were not available based on, on the supply chain of management here. So the first thing we did, the first operations principle I was able to institute was, “Hey, let’s redistribute these mass vaccination super sites into more geographically dispersed areas.

[00:06:54] Randy Kelley: And we set those up for in-car or mobile vaccinations. You see here, we went from two cities to well over 15, possibly 20, cities throughout the state.

[00:07:09] Randy Kelley: You can see what one of these sites looks like in this picture right here. This is Randolph County, North Carolina. These now dispersed sites greatly [decreased] traffic ingestion and gave more customers access to these vaccination clinics. The results were rapid and total throughput. Throughput shot through the roof for the whole state.

[00:07:35] Randy Kelley: Once that was taken care of, we turned our attention basically to standardizing the process at these mobile and walk-in clinics. You’ll see a walk-in clinic right here, I think, in Statesville, North Carolina. We weren’t able to affect some changes on such short notice. For example, we had double data entry for these customers, and they had to fill out an online form before they ever showed up.

[00:08:02] Randy Kelley: And when they did show up, they actually filled out a very similar paper form. However, we were able to specifically identify where we wanted to control this bottleneck. So let’s take a quick look at that bottleneck. When the vaccines defrosted from a cold storage, it’s drawn up on site and has to be used that day or be discarded at the end of the day.

[00:08:27] Randy Kelley: Most of these sites were batching doses early in the morning and then discarding thousands of dollars of vaccines at the end of the day, or more often. They were running short and turning away patients through online scheduling. We went from individual scheduling to basically batch scheduling, meaning, for example, 50 people could come.

[00:08:50] Randy Kelley: During this 15-minute section, we were able to forecast daily demand, and I added a variability buffer of that, of uh, 8%, based on empirical data over the preceding few weeks.

[00:09:08] Randy Kelley: We would then not draw the dose until a patient signed, and that dropped the vaccine waste to almost zero. You can see here the flow diagram of what it looks like, and the vaccine draw was triggered by the patients signing it. When we focused, that was able to make the process much, much more efficient without wasting vaccines.

[00:09:35] Randy Kelley: We then focused on cross-training all these personnel in order to provide sitewide and then, even eventually, statewide capacity increases because we were in the midst of a severe healthcare worker shortage. If you remember, many of these nurses were just, there were not enough of them to give these vaccines.

[00:09:55] Randy Kelley: So with a relatively smooth process going on at vaccination sites, one of the CEOs came – the company came to me and asked if I would look at his back office and man was I in for the shock. The first thing I saw was a room full of registration forms, a wedding entry into the statewide system of counting.

[00:10:14] Randy Kelley: Obviously in operations scientist science speak, we call this visible work in progress or WIP. In this picture you’ll see about 130,000 registration forms. And each of them represented about $144 each, in invoices. That total is $18.7 million in revenue, just waiting for E for entry,

[00:10:43] Randy Kelley: and this was just one month of vaccine forms. So my first comment was something about the time value of money, to which the CEO, a fine doctor, by the way, gave me a blank look. He admitted that with the demand of the vaccine so high, he was putting all his efforts into administering the shots throughout the state and ignoring the quickly growing piles of forms needing data entry.

[00:11:07] Randy Kelley: At this point in time, he was sitting on over $18 million in revenue and invoices while shilling out millions of operational expenses.

[00:11:18] Randy Kelley: So we, I, immediately mapped out a process and we moved 20 employees into the back office to run a conga line and run the clock in shifts. We were able to move from a medical billing of once a month to twice weekly schedule, getting a much needed flow of cash throughout the company. Additionally, data entries had about a 30% error rate.

[00:11:40] Randy Kelley: Yeah, 30%. We knew that because patients would call and complain. So we instituted a quality control check while the data worker had both online documents open and the paper document at once. Error rates were now calculated daily and dropped significantly. Over the next few weeks, we continued to improve all the existing processes while initial demand for the vaccines eventually began to dwindle with a dropping demand for the vaccine.

[00:12:10] Randy Kelley: The recommended technology improvements were sidelined, but the key operational improvements continued to pay off.

[00:12:20] Randy Kelley: So in conclusion, the experience was not unlike the deployment of operations science to construction projects for many of the companies represented here. And just like many of those projects, these concepts may be introduced mid-project, just before things really start to break down.

[00:12:39] Randy Kelley: This obviously creates tension within the project and, like Dave McKay said earlier, “Hey, if we start implementing operations science early, but even if not mid-project, just do it once adopted.” However, the principles do amazing, amazing things for project completion. In this case, the extreme lack of operations knowledge with these healthcare professionals, coupled with some key wins, gave these managers some very strong desires to learn and implement these principles, so they’re hungry for this knowledge.

[00:13:16] Randy Kelley: I really did enjoy working on this project, especially when I could see immediate results, which is not always the case, especially in oil and gas and in construction. But it did, obviously and you can see it in real time. I hope you enjoyed hearing a little something different from what you’re, what you may be used to, but still relevant to the greater project production management movement.

[00:13:43] Randy Kelley: And at this time, I’d love to hear your comments and questions.

[00:13:48] Roberto J. Arbulu: Thank you, Randy, so much. And this is actually quite impressive what you have done on the vaccination program and the ability, putting into practice some of the operation science principles. Right. And this is something that Todd mentioned in the session earlier about modern construction – you know, if you’re looking to modernize construction or any sort of production system, really focus on understanding operation science.

[00:14:16] Roberto J. Arbulu: I think your story, it’s a validation of that, and there’s actually some observations and as we get some questions from the audience, I will be passing them to you. Okay. But there’s something that really caught my attention and you were saying that you moved from, one of the strategies you put in place is trying to schedule the appointments, right?

[00:14:41] Roberto J. Arbulu: Yes. One upper size, time and moving for a larger chunk of time where there’s more flexibility. Right. For people to come in and get vaccinated. Right. Did we get that correctly? (That is correct, yes.) Right, so you basically, for a specific chunk of time, you eliminated the scheduling, right? (Yes. As the way forward or the way to do it.)

[00:15:07] Roberto J. Arbulu: The reason why this is a very important highlight is because we see that a lot in projects, right? You also have experience in projects. Working in oil and gas to some extent. And, you have seen how teams are really driving for scheduling, right? (Yes.) This is actually allowing the production system to be the one that is more flexible and

[00:15:37] Roberto J. Arbulu: allows the increase to triple. So the question for you is, can you say more about that? I mean, what, tell us more about that change from scheduling for a specific time to sort of a more flexible perspective. Not scheduling to some extent.

[00:15:53] Randy Kelley: Absolutely, and this was a hard one for many of these CEOs, as well as the administrators throughout the state, to actually understand – that it was more advantageous to do something like this.

[00:16:04] Randy Kelley: They wanted, in medical organizations, you know, if you’re John Brown, you show up at this time. And so they’re, they were so used to that, that when you’re dealing with thousands and thousands of people on a daily basis, it really wasn’t relevant to the throughput of the entire process.

[00:16:29] Randy Kelley: So I was able to, and they took it on board and it took a few, even before this, there were some customer complaints saying, “You know, I had a 10 o’clock appointment and I had to wait for an hour before I could actually be seen.” So, it was easier on the entire system for these chunks of people in these chunks of time, with capacity variability at the site, to be able to handle those.

[00:17:05] Randy Kelley: And once we controlled the bottleneck, which was the one we wanted to, which was the actual vaccine draw, everything else was able to just to flow from that.

[00:17:18] Roberto J. Arbulu: Excellent. So I do have a comment for you that one of the members in our audience wants to pass to you, which is in a great different industry, but similar experiences and results.

[00:17:29] Roberto J. Arbulu: Right. And it’s probably worth talking a bit about what he’s saying because, you know, what you did is look at the vaccination production system, right? (Yes.) And what the vaccination production system produces is a person vaccinated, right. You, me, anybody. (Right.) The question is, what happens in that production system to get a person vaccinated?

[00:17:54] Roberto J. Arbulu: You highlighted the working process and the picture of all the paperwork is picked by itself. There’s another question for you here. So we have someone saying, amazing. How widely are these principles being applied now based on what you know in this sort of approach?

[00:18:14] Randy Kelley: So here was my observation.

[00:18:17] Randy Kelley: The companies, for example, Pfizer and Moderna, have their operations science principles working because they’re used to this type of ramp up. Operational Warp Speed was just a typical production line that they are used to doing. Once these vaccines came outside of the company into the hands of health departments and then subcontracted companies,

[00:18:51] Randy Kelley: the knowledge of operation science was nowhere to be found. Nobody knew what to do with this and how to work this. So in my experience, I only saw a few other states. I went to Puerto Rico, looked at their system also, but, none of them understood the operation science principles. Once I introduced this in North Carolina, they understood it, that it worked.

[00:19:19] Randy Kelley: They didn’t really understand exactly why it was short-term. We were right in the middle of some major demand and in working those issues. But my experience with government officials is that they’re hungry for this. They may not be incentivized to make it all work quickly as, for example, some of the companies who had revenue sitting around right, right.

[00:19:48] Randy Kelley: So,

[00:19:48] Roberto J. Arbulu: okay. Thank you Randy, so much. And, you know, a lot of similarities from previous stories we have seen, right. The use of operational science, you know, that drives the behavior of the production. Two, looking at what you are doing, what the teams are doing as a production system, right? There’s a throughput that you want to get – target.

[00:20:08] Roberto J. Arbulu: The implications of having a necessary working process in the system, right? Not getting enough throughput out of it, and in a completely different way, I will say, within this context on what we’re doing. So a lot of similarities as well with the article that PPI published earlier this year.

[00:20:28] Roberto J. Arbulu: So thank you, Randy, on behalf of PPI for your participation and bringing us your story. Very powerful. Very, very good. Amazing. Yeah, definitely.

[00:20:37] Randy Kelley: My pleasure. And the funny thing is, I actually didn’t have the chance to read this article before I did this. So the operation science I’ve learned doing construction just naturally applied to this very quickly.

[00:20:52] Roberto J. Arbulu: Excellent. That’s good, too. Thank you so much. Appreciate it. My pleasure. Thank you.