The vaccine clinic was not busy. In the past week, we had probably given most of the Pfizer boosters we would be doing, while waiting for the Moderna ones to be approved. We had 75 people that day, a far cry from 600 the first day of boosters, and 2500 at Autzen Stadium in our prime back in spring.
Only a few volunteers were needed, and we were overstaffed, so I was the person who would direct people to the vaccinators from registration. Since the vaccinators had little green flags they could wave when ready, patients could easily find their way without me. I was there, overtrained, a bit superfluous, another check in the system, but I decided that every job is important, and I would make this one important, too.
I began choosing vaccinators in order, counterclockwise, not that the direction mattered. I had learned their names, telling them what I would do. I had been at many clinics where the nearby vaccinators were busier and those more distant were not, and clearly wanted work. As the clinic started, I wrote down who had received patients, and as the day unfolded, I started using hand signals, letting vaccinators know when they were next, second, or third. I wasn’t bored; nor did I see any vaccinator frustrated that they weren’t seeing as many patients. By the end of the day, one vaccinator who felt she never got enough work (I thought she did) said the system worked well. I took a lowly job and made another job more efficient and more meaningful, making mine more meaningful as well. Big lesson.
I became a greeter in another clinic, when we also had many volunteers. I was the face of the clinic. I kept some visitors from entering when they expected a booster and we didn’t have permission to do so. We had a door for first and second shots and another door for third shots, back when the third shot was only for those with immune system compromise. We wanted to keep those people separate, and I could do that outside. The numbers weren’t large, but I had a chance to explain to people what the difference was between third shots and boosters.
When boosters were allowed, we had people in line with appointments as well as walk-ins. I was at the initial checkin desk, busy, lots to do, to say, and tried to move patients with their clipboards to where they could fill out information. The line outside didn’t concern me. I figured it never would, but those in that initial role were later required to have access to the state database of vaccinations, and I didn’t qualify. I went back to checking registration, unless there were enough doing that, at which time I became the greeter. The line then did concern me.
When the Moderna boosters began, we had nearly 1000 people a day for the first week. Greeting people individually was no longer feasible with 50 appointments scheduled every quarter hour. We weren’t going to be at the clinic the first day of shots, but I suggested beforehand the lines be separated into appointments and walk-ins. On the second day, my wife and I were assigned to the nearby drive through line. When we walked towards “the barn,” for our late morning early afternoon volunteer shift at the clinic, I said, “Oh my God,” looking at a 75 yard long line of people outside, inside another 10 yards to the check-in desk. As we walked past the line, I heard several complain, “I have appointments and walk-ins are going ahead of me,” “Appointments don’t matter here.” That hurt.
Inside, we learned that two lines were tried but, “it didn’t work.” I didn’t buy it, but in any case had to go to the drive through shot clinic that day, the first one in nearly five months, only three lanes, not fourteen. The weather was sub-optimal, rain and moderate wind, but we had 30 vehicles come through, a lane for Pfizer, one for Moderna, and one for all vaccines as a spillover. I was back in outside registration and liked it.
My wife had a few more vehicles in her line, and I was free, so I walked back over to the clinic, where the line was still about a third as long as it was. I started telling those in line there was a drive through clinic 100 yards west of the building. One person with a bicycle asked if it were faster. I nodded. Another asked if she could walk through it. I said yes. Several others left the line to go to their cars and headed over to the car line. I apologized to people in the line, saying that “we are going to fix this, but unfortunately that won’t help you today. I’m sorry.”
The line emptied, as if I had just mentioned free beer next door, and the car line became busier, which is exactly what the vaccinators wanted. I returned there in time to see the bicyclist get his shot and later to help the person who walked through.
After the clinic was over, I went to the registration lead and asked if we could have two separate lines the next day, one for walk-ins, one for appointments, with appointments prioritized about 6 to 1. I was going to hike that day, but I cancelled as this was more important, volunteering to be greeter.
We had two lines, a much shorter walk-in line and a long appointment line. My wife worked outside; I at the doorway. The clinic got an early start, so several with appointments were seen well before their appointments. The walk-ins were all seen, since they were not interfering with anyone with an appointment. We held our own for 45 minutes, and then it got busy, as we had insufficient capacity for 200 people an hour. The line got larger, but it never was more than half the size it was the prior day.
I certainly got complaints—three to be exact—that the walk-ins were getting priority over the others. The comments were about unfairness, and after the third such, I said, “Look, I joined the Navy in 1973 , and two months later, they abolished the draft. That wasn’t fair.” That got a good laugh from the line, full of people in my generation We worked solidly for 3 1/2 hours, my juggling both lines, and the line inside the doorway behind me with a lot of “See that person over there? When they vacate that spot, you take it.” They could see and move; I could concentrate on others.
The following day we ordered people by the time of their appointment. The morning went well. We had the line expand in the late morning, but it got into control, and I had time to eat lunch without 5 minutes between bites. When I returned to the front door of the clinic, my wife, also working there, came up to me, “It’s a real mess out there. Nobody was managing it while you were at lunch.” I went outside.
There were two lines of about twenty each. I turned to the line on my left, the appointment line. “How many of you are walk-ins?” I asked. Half raised their hands.
I then turned to the right, the walk-in line, and asked, “How many of you have appointments?”
Half raised their hands.
I then lifted my arms over my head and crossed them, so the hands were facing opposite directions.
“Everybody who raised their hand, please change lines.” Problem solved. The following day, I was volunteering in the woods, and I learned afterward that three lines were tried, and it was the worst of any of the days we had, people lined up 100 yards from the door.
On the last day that week, I was the greeter with no help. The first thing I did was talk to the security person in the parking lot. He explained what happened the previous day and what changes had been made. He had a direct line of vision to the drive through clinic and could see how many cars were waiting, so he could know when it might be feasible to send more people in cars there, rather than through the line. He suggested two lines, not three, which made sense.
We opened early, prioritized appointments, and allowed walk-ins when we had time before the next appointment group, otherwise about a 6 to 1 ratio of appointments to walk ins. One person complained, and I didn’t agree with her, but I kept silent. One man told me I had the most difficult job there. He might have been right. In the clinic, helping those in line to get in is minor. But if it is handled well, people stat the process with a decent frame of mind, which is what we wanted.
Deming said to optimize the system. Listen to those involved and value their opinions. Every job is worth doing well.
And no, life isn’t fair.
Boreal B[l]og 