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OperationsProductivityService Improvement

Vaccine Lean – The Dawn of the Water Spider

25 October 2022

One of my favourite things to do is … encounter a slightly less than optimal service experience where I can very quickly identify a series of things that could be done differently to bring about better flow.

This makes me feel good about myself.

I wrote about receiving my 3rd Covid vaccine here for example – Vaccine Lean.  If you click the link, or even reminisce on how many minutes of your life reading that blog involved, you’ll remember that that was an extra long one because I wrote it over two luxurious weeks of Christmas leave. This blog won’t (probably thankfully) be as long because I am currently on a next day blog deadline, plus it won’t be as accurate a representation of my fourth covid vaccine experience, mainly because it was so bloomin’ fast!

It was so fast I couldn’t take detailed mental notes in readiness for writing another blog.  To be perfectly honest with you, the fact that the experience was so considerably improved was a bit of a surprise to me!?! I was just expecting another long wait and blocked my calendar out accordingly. But lo! Someone with some operations management knowhow had definitely had a look at the process and is subsequently winning at life! My end-to-end jab experience was 8 minutes, as compared to over an hour in December 2021.  Major result!

Now this process was using a different design to the one I suggested (Curses… I still suspect mine would be faster.. but as I discussed in my first blog, maybe it would be too fast?  To be honest even 8 minutes felt frighteningly quick!) but critically, many of the things I suggested were evident.

I shall detail them now as follows:

  1. There was clear flow. An entrance and a different exit within a tunnel like building. It is amazing how much dynamism can be achieved by such design.  Yes there will be obvious advantages in the reduction of transportation and employee motion, but we can also look to psychology here I think..  in that there is a sense of movement about the operation which automatically sets a tone of pace. Like a moving production line, you can’t hang about, you have to move, move, move, move (subtle Beyonce quote).
  2. Vaccinators stayed put! They were no longer looking for the next patient, collecting them etc. They were focused to task, inputting onto the computer and vaccinating the patient. All of the cubicles were full which meant that they were dedicated to the task at hand. This radically increased the throughput.
  3. They had a mizusumashi (nice video to explain what this is here – noting that you can have automated ones too e.g. Toyota mizusumashi) – aka a water spider supply delivery mechanism – basically a person whose role was to ensure that each cubicle had the necessary vaccine to administer to the patient, ensuring that the vaccinator didn’t have to move about. (You can see that I have cunningly merged a human icon, with a spider icon, to illustrate the role on my graphic – proud of that one). He was roaming around the cubicles looking for a coloured vaccine tray and ready to supply an unused injection. This is a really important principle that lots of operations don’t get actually, how can you protect the end-to-end value stream with as much ‘value add’ as possible? You achieve this by pushing the wastes of ‘waiting’ and of ‘transportation’ and ‘motion’ outside of the end-to-end value stream – this is what the water spider role does and achieves – it takes on the ‘waste’. The ‘parts’ (vaccines) are there when and where you need them, protecting the end-to-end value stream from ‘wasteful’ activity.


All in all it was a very impressive experience. I’m not going to nitpick on where there could be improvements because I am not a total monster and anyway, as I suggested, it was fast enough. Any faster and it might have been truly terrifying.

This success is really exciting for Wales I think.  There are so many problems that we are up against right now… the cost of living crisis, the ongoing war in Europe, the fact that Truss’ ‘mini budget’ has set us back years and cost the UK tens of billions, Brexit (it’ll never be ‘done’) and yes, the massive backlogs in healthcare, but look at what can be achieved with some operations management thinking?!  I genuinely believe that with some creativity, experimentation and a readiness to ‘think more like a factory’ some of these backlogs can be dealt with really effectively and we can get on top of things again.