Back in early December 2020, I published a blog post praising Operation Warp Speed (OWS) for the speed and coordination of the Covid-19 vaccine development process. I identified three valuable lessons that any organization can adopt to enhance processes and productivity.
I was uneasy at the time because I feared that the story wasn’t over. Vaccines only work when they are administered. The next chapter—vaccine distribution and actually getting the vaccine into people’s arms where it can do some good—has proven to be a much less happy tale.
The problems that have plagued the initial roll out of the COVID-19 vaccines in the United States are a vivid example of what can go wrong in any large complex end-to-end process: poor planning or no planning for distribution; inadequate resources and funding; unclear accountability and coordination; competing departments and agencies; and confusing communication.
While this huge vaccine rollout dwarfs anything in the private sector when it comes to scale or life and death consequences, these five systemic errors could apply to any organization and complex initiative. They can also be avoided. I am not a healthcare expert, but I have been avidly watching this unfold from the vantage point of APQC, where we have been studying how to manage and execute complex multidisciplinary and multi-department/agency processes for decades. The following are tools that can help avoid or alleviate these problems. The vaccination rate will get better—this is a rapidly evolving situation and a lot of improvisation by smart, resourceful people and institutions is helping. But in the meantime, let’s diagnose, treat and learn from what happens when we don’t manage large scale, end-to-end processes well.
1. INADEQUATE PLANNING
OWS spent $28 billion to develop, test, and regulate vaccines. Not a penny was spent on distribution planning or providing money to the states who had to execute the largest vaccination campaign in U.S. history.
Even without funding, the states could have at least done tabletop planning exercises. In contrast, early in the pandemic many organizations pivoted well and quickly when they had to transform development, production, and delivery. The grocery industry is a good example. H.E.B, the largest grocery chain in Texas, started conducting scenario planning to cope with potential COVID-19 supply chain disruptions. They did this as soon as they got word of the virus in Wuhan, China and well before it was clear how serious the virus would be in the United States. Large hospital systems are another example as they seem to have done a better job planning and aligning resources for vaccinating their patients.
Scenario planning is a great low-tech, tabletop tool for simulating future situations under uncertainty. These APQC resources will help you get started: Scenario Planning Fundamentals: Illuminating Possible Futures and How Scenario Planning Helped NASA Adapt Fast to COVID-19.
Even the best scenario planning won’t help you if you leave out essential players. Considering the entire end-to-end process is a foundation for determining the impact of various scenarios. Again, proven tools for taking this end-to-end approach are available: Driving Collaboration and Value Through End-to-End Processes and End-to-End Process Maps and Measures.
2. LACK OF FUNDING AND RESOURCES
The U.S. states and entities were charged with getting the vaccine distributed and administered without any funding at a time when their revenues were severely hurt by the recession and joblessness. The decision to punt much of the work of vaccine distribution to the states left many local health officials overwhelmed, saying that they didn't receive sufficient funding or resources to handle the work of administering doses.
According to emergency physician and former Baltimore Health Commissioner Leana Wen, MD, “The states were asking for $8 billion to beef up their public health infrastructure because local and state health departments were already substantially underfunded even before the pandemic. Then they had to take on testing, contact tracing and quarantine, vaccination tracking, and public education. So they were asking for $8 billion to bolster that capacity, to hire new staff, to set up vaccination sites and so forth, and to change the IT infrastructure for many places that have really outdated infrastructure. They did not receive this funding.”
Sound familiar? Managers often find themselves owning a project without funding or people to execute. Heroics can sometimes work, but as a general rule, you get what you pay for in project management.
The December 28, 2020 COVID-19 Relief Bill would have contained some funding, but that provision was dropped in order to pass the legislation. Bless the bipartisan Problem Solvers Caucus and their eight Senate partners for getting the bill passed—but they had to give up state and local relief, which would have included money for vaccine rollout.
It now appears that even $8 billion would not have been enough to stand up a nationwide campaign. Current estimates are that a minimum $25 billion is needed. Regardless of what the final number may be, scenario planning exercises early on with all the players at the table could have done a better job of estimating how it would get done and the resources required.
3. UNCLEAR ACCOUNTABILITY
Another all-too-familiar issue in complex, cross-functional projects is the confusion and conflict between departments regarding who has accountability and what they control. OWS defined their job as getting the vaccines developed, approved, and distributed to the states, not administered to recipients. "CDC (U.S. Centers for Disease Control) made it very clear that they owned working with the states on the last mile of getting people vaccinated—that was their turf," said one U.S. Health and Human Services official involved in the vaccine project.
By not treating this as an end-to-process, the ball (or in this case the vials) got lost in the white space between the R&D (i.e., OWS) and the distribution and delivery stages. Again, thinking end-to-end process is essential for effective planning and a foundation for determining the impact of various scenarios.
4. COMPETING DEPARTMENTS
Infighting, finger pointing, and juggling for control plagued the vaccination distribution picture from the beginning. There was lack of coordination from development to the final mile which required coordination with the CDC, states, and actual delivery vaccination “hubs.”
Along with upfront planning and funding, a first step to combating and preventing both unclear accountability and competing departments is to use RACI charts to clearly define roles and accountability. APQC has seen this work in major innovation and complex process improvement projects. We have shown hundreds of organizations how to use RACI charts complemented with other management strategies for cross-functional projects. Here are a few more APQC resources to get you started on recognizing and addressing the difficult issues related to competing departments in complex processes.
» Culture Clashes: Misalignment and Consequences
» When and How To Integrate Process, Knowledge, and Data Management
» Breaking Down Silos for Operational Excellence
5. CONFUSING COMMUNICATION AND OVERPROMISING
Communications have been troubled since late November 2020 when the vaccines were approved for emergency use.
Overpromising has been one problem. Well intentioned OWS leadership, trying to reassure the public, over promised vaccine delivery and celebrated too soon.
"By the end of this year, 20 million Americans could be vaccinated," Alex Azar, former U.S. Secretary of Health and Human Services, effused on Dec. 14, cheering as the first shots were administered at George Washington University Hospital. "By the end of January, 50 million Americans could have had a first vaccination."
There has been confusion regarding who is eligible and how much vaccine is available to the states. The public hears media stories about healthcare workers, afraid a vial of precious vaccine would go bad, rushing to give the vaccine to anyone available. So they line up.
OWS's top logistics official apologized for misleading states and admitted the federal effort had wrongly inflated estimates. “It was a planning error, and I am responsible,” Army Gen. Gustave Perna said last month. “We’re learning from it. We’re trying to get better.”
My advice is: “Mute the trumpets. Don’t over promise then under deliver.” Let the results speak. Give ranges and shoot for the top one. Take a page from the book of economists about making predictions that are uncertain. Here are some APQC resources to get you started.
» Communications: A Core Capability for Organizational Resilience
» Effective Communications in Times of Change
» Identify Stakeholders and Their Levels of Commitment
» APQC’s KM Communication Plan Template
Closing Thoughts
The vaccine distribution has stumbled out of the gate because it has not been treated as an end-to-end process and because it has not been supported by deeper planning up front, adequate funding, accountability, and clear communications.
Nothing changes the fact that the world owes an enormous debt of gratitude to everyone involved with OWS. Working together, in record time the OWS leaders and taskforce, pharmaceutical firms and contractors, the U.S. Food and Drug Administration and CDC (and the political leaders on both sides who gave them funding and cover) developed game changing and life-saving vaccines against SARS-Cov-2, the virus that causes COVID-19. Their remarkable approaches will speed future drug and vaccine development for years to come.
But that remarkable feat will only pay off when we get vaccines administered at a much faster rate than we are now. Pray that lessons get learned and the situation improves immediately.
Lives literally depend on it.