“Flying a plane and building it at the same time”: Lessons learned from the dynamic implementation of mass vaccination clinics in the Region of Waterloo, Ontario, Canada

doi:10.21203/rs.3.rs-2377668/v1

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Research Article

“Flying a plane and building it at the same time”: Lessons learned from the dynamic implementation of mass vaccination clinics in the Region of Waterloo, Ontario, Canada

https://doi.org/10.21203/rs.3.rs-2377668/v1

This work is licensed under a CC BY 4.0 License

Journal Publication

published 03 Oct, 2023

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Background

Vaccination plays a critical role during pandemics, and mass vaccination clinics are often an imperative public health measure. These clinics usually consist of multi-disciplinary teams, which can pose significant coordination challenges, yet also presents an opportunity for collectively contributing toward mitigating the impact of infection within communities. This study explores the coordination dynamics of the Region of Waterloo’s Coronavirus disease of 2019 (COVID-19) mass vaccination clinics in Ontario, Canada, between July 2021 to April 2022.

Methods

This qualitative study included sixteen purposively selected participants working in mass vaccination clinics. Participants were individually interviewed for 40–60 minutes. An inductive and iterative thematic analysis was undertaken, including open coding, grouping, labelling, regrouping, and making sense of the themes.

Results

Three interrelated themes were created: (1) Unpredictable Work Environment, which comprised of changing clinic processes and the impact of clinic adjustments to the running of the clinics, (2) Clinic Cohesion Challenges, which included staff role disparities, limited job preparation and clinic system silos, and (3) Adaptable and Supportive Work Environment, which comprised of staff adaptability, dispositional flexibility, and a supportive work environment. While the first two themes created a precarious situation in the clinics, the third countered it, leading to a largely successful clinic implementation.

Conclusions

The rapid evolution and high transmissibility of COVID-19 in communities required a public health response that felt like flying and building a plane simultaneously—a seemingly impossible yet necessary task. However, an adaptable and supportive work environment was critical for establishing an atmosphere that can overcome challenges from a constantly changing pandemic and the guidance of public health officials. Such lessons gained from understanding the dynamic experiences in mass vaccination clinics are essential for improving the development and operation of future immunization campaigns.

COVID-19 Pandemic

Mass vaccination clinics

Dynamic implementation

Multi-disciplinary teams

rapid evolution

Unpredictable and Adaptable

The trajectory of coronaviruses is unpredictable [1–4]. Regardless, the role of public health is to protect the public, particularly the most vulnerable, by monitoring, preventing, and promoting people’s health in their communities [5]. The ongoing COVID-19 pandemic has been challenging to predict, and it continues to result in constant change to public safety measures and person-to-person transmission mitigation recommendations since the World Health Organization declared COVID-19 a global pandemic on March 11, 2020 [6, 7]. A significant intervention measure toward reducing the impact of COVID-19 on public health is vaccination, one of several strategies that continue to be used to minimize COVID-19-related hospitalizations and mortality [8]. Through unprecedented cooperation among global partners, the first vaccine to protect Canadians against COVID-19 was approved by Health Canada on December 9, 2020 [9]. However, approving the first COVID-19 vaccine has only been the first step in a dynamic cascade of events during the mass COVID-19 immunization campaign.

When vaccines are available to lessen the impact of severe disease and the demand for vaccination by communities is high, public health organizations face considerable pressure to implement mass immunization campaigns as effectively and efficiently as possible. One approach is through mass vaccination clinics [8, 10]. Implementing large clinics requires a multi-disciplinary approach [11, 12]. Public health nurses, pharmacists, physicians, non-clinical staff, students, and volunteers are needed to work together to ensure that the immunization environment, which is often a non-clinical space, meets the unpredictable needs and safety requirements of the characteristics of the pandemic [10, 13]. The heterogeneity among mass vaccination clinics in past epidemics revealed some challenges of effective coordination within and amongst sites [10]. For example, during the swine flu pandemic (H1N1) mass vaccination clinic campaign in 2009, Canadian public health nurses faced considerable challenges in effectively preparing for their supervisory and immunizer roles [14]. The challenge associated with balancing the required positions and staff schedules with community demand has also been identified [10]. Even during the COVID-19 pandemic, early literature reiterates the importance of proactive communication methods among staff and appropriate scheduling [15].

Understanding the experiences of frontline public health workers adapting to changing community immunization needs during a global pandemic is crucial to inform workforce capacity and organizational decision-making for whenever the need for the next mass immunization campaign comes again. Prior studies focus on short-term or simulated experiences [10, 16–21], which provide initial insights but do not include the sustained impacts of an unpredictable global pandemic such as the one caused by SARS-CoV-2. Hence, this study explores the evolving experiences of a multi-disciplinary sample of frontline workers of the COVID-19 mass vaccination clinics in the Region of Waterloo between July 2021 and April 2022.

Study design, selection of participants, and data collection technique

This qualitative study explored the dynamics of COVID-19 mass vaccination clinics. The participants were purposively recruited clinic staff that worked at the mass vaccination clinics in the Region of Waterloo. They worked at several sites, including three large clinics, one large pop-up clinic, one small clinic, and various mobile pop-up clinics throughout the community. An initial recruitment email was sent to all clinic staff soliciting their interest in sharing their experiences at the clinics. Those who expressed interest were interviewed until concept saturation was reached, which was agreed upon through consultation with the researchers (MT and RT) who led the data collection process. The Region of Waterloo is located in southwestern Ontario, Canada and has a population of 620,000 residents as of 2020, with a mix of urban and rural communities [22].

Sixteen volunteers were individually interviewed in English for 45–60 minutes virtually via Microsoft Teams. Each interview was audio-recorded and automatically transcribed verbatim in preparation for analysis. Simultaneously, MA and AB supported cleaning the transcripts, removing any direct identifiers, and correcting the automated version while listening to the recording, if needed. After each transcript was cleaned, they were exported to Taguette 1.3.0 for qualitative analysis to aid the coding process. After conducting the first three interviews, MT and RT reflected on their interview notes and discussed emerging issues that needed further exploration. These discussions not only helped to identify points of saturation [23] but also helped in further refining the interview guide and probes.

Data analysis

MT led the data analysis process by working collaboratively with RT, MA, and AB. The process started with the four researchers collaboratively developing a codebook. The codebook was created through an iterative process in which each researcher independently coded one common transcript and met to compare generated codes. This was done for two interviews and then holding discussions to establish a joint codebook. The discussions involved renaming, removing, or merging some codes to arrive at the joint codebook. The open coding continued to be refined by MA and AB as they coded the remaining interviews.

The final codebook contained a total of 230 open codes; 100 codes were collaboratively selected as relevant to exploring the adaptive dynamics of the COVID-19 mass vaccination clinic context. The 100 codes were then grouped and regrouped through an iterative process that yielded themes and sub-themes applicable to the subject of analysis. Next, the completed, thematically organized codes were shared with the entire research team for review and sense-making. This process involved discussions with senior team members (NW, CMB and KG) and led to an agreement on the results, which all authors reviewed to provide varied and rich insights.

Three interrelated themes were developed from the qualitative analysis (Fig. 1). While the clinic staff struggled to establish successful clinics amid an unpredictable work environment and challenges with clinic cohesion, they were able to create adaptable and supportive clinic environments to operate COVID-19 mass vaccination clinics successfully. What follows are insights into the difficulties in balancing the need for agile emergency responses with informed and supported staff.

Unpredictable Work Environment

A common analogy used by participants was “flying a plane and building [it] at the same time” (Interviewee 008). While noting that the “plane did fly,” this analogy highlights the unpredictable work environment theme that clinic staff navigated within the clinics. This theme is explained by two subthemes: changing clinic processes and the impact of clinic adjustments. Unplanned changes to staff schedules and clinic processes impacted clinic staff, contributing to an unpredictable work environment. As shown in Fig. 1, this theme and the limitations to the clinic cohesion theme hindered the optimal implementation of the COVID-19 mass vaccination clinics in the Region of Waterloo.

Changing Clinic Processes

Changes to clinic processes, such as vaccine eligibility, screening procedures, vaccine delivery techniques, and staff roles, contributed to unpredictable changes to clinic workflow and processes. Many of these modifications were due to the rapidly changing nature of the pandemic. While this was recognized by clinic staff, many noted that the experience felt “like a rollercoaster.”

“The clinic was going through a bit of a transformation. Honestly, it was always transforming.” (Interviewee 001)

“We have to go with the newest things every time, like things are changing all the time.” (C003)

Participants found their roles to be dynamic and variable, a consequence of evolving vaccine clinic modalities, including mass vaccination clinics, pop-up clinics, drive-thru clinics, and vaccination buses. They transitioned between roles throughout the day based on the current state of the pandemic and the specific needs of the clinic environment. Participants had to be prepared to cover multiple positions when needed, contributing to an unpredictable work environment. For example, supervisors noted that on some days, they would start the day welcoming clients to the facility and later find themselves covering at the clinic check-out station.

“There is no consistency. There is still no actual job description for the roles since the pandemic is evolving, and everything has evolved with it.” (Interviewee 007)

Impact of Clinic Adjustments

Toward the beginning of the mass immunization campaign, participants explained that the clinics were often overstaffed, which created an unnecessarily hectic atmosphere. Some participants felt they were not needed for the entire duration of their shift and suggested scheduling staff for shorter shifts.

“The place was literally crawling with staff. It was overstaffed like crazy for the first little while.” (Interviewee 008)

As the immunization campaign evolved, clinic supervisors expressed concerns about the stress and burnout of clinic staff and the potential impact this could have on the safety and effectiveness of the clinic. They had busy schedules, working long hours, often without breaks or weekends off, to maximize community immunizations.

“I was burning out. After working 13 to 15 hours every day for weeks on end without a weekend off, I didn't want a clinic environment where you had management staff who ended up calling in sick… who weren't taking breaks because they had too much going on.” (Interviewee 002)

Generally, an ongoing contention was that these adjustments made it challenging to know what to expect and plan for each day in the clinic.

“At times, the response was reactionary, and that often led to a domino effect of other unforeseen consequences.” (Interviewee 006)

Clinic Cohesion Challenges

Clinic cohesion challenges included three sub-themes: staff role disparities, limited job preparation, and clinic system silos.

Staff Role Disparities

The clinic staff included health professionals with many backgrounds, such as nurses, pharmacists, family doctors, retired surgeons, and paramedics. Given the diverse professional backgrounds of the clinic staff, one source of indirect conflict was differences in compensation. Participants noted pay discrepancies between physicians and other immunizers, suggesting that physician efforts should be redirected toward other areas of the pandemic response.

“We found that doctors were being paid [much more] to do the same job as a nurse. As a nurse, I was not happy to hear that… it’s a waste of healthcare finances. They should be taking care of patients and relieving the load of the nurses in clinics or hospitals.” (Interviewee 001)

“During business hours, doctors are paid $170 or $220 an hour to vaccinate… as a citizen, as a taxpayer, as someone who values the healthcare system at large, I think that that was foolish and unfair.” (Interviewee 002)

Further, conflicts between clinic staff and supervisors were another limiting factor in clinic cohesion. Disagreements often arose about using scarce resources, such as opening a vaccine vial toward the end of the clinic’s scheduled hours. In addition, running a clinic when vaccine supplies were low was considered an unnecessary use of resources.

“If we had challenges with vaccination supply, then we shouldn't have run a clinic. We should have complemented the staffing [at another clinic]. We ended up using resources that were unnecessary.” (Interviewee 003)

Participants reflected on the mobile clinics—some of which were deployed on retrofitted public transit busses parked in an accessible location—operating differently than the mass vaccination clinics and how this impacted staff capacity and burnout. While mass vaccination clinic cohesion was disrupted when staff were overburdened, mobile clinics, with smaller staff numbers, were more easily overwhelmed and stressed.

“[For the first mobile clinics], we had a small team of nurses that were not COVID deployed yet. They were overburdened and over capacity. They exceeded the actual hours they were supposed to be working on a weekly basis.” (Interviewee 006)

Limited Job Preparation

In our study, clinic staff participants reflected on their journey within the evolving mass vaccination clinics. “Hitting the ground running” was a common sentiment among participants and may have contributed to the staff role disparities described above:

“You were flying a plane and building it at the same time.” (Interviewee 008)

“We were pretty much everything. We were a nurse. We were also [human resources]. We were also [information technology support]. We were security.” (Interviewee 003)

Planning the procedures and operations of the mobile clinics during their implementation was challenging for clinic supervisors, particularly when onboarding other staff. The participants with this experience initially felt they had limited knowledge about how to operate a mobile clinic, leading to feeling overwhelmed and anxious, in addition to pressures from public health to get doses into arms.

“At face value, it looked like it was a well-oiled machine. I'd say it was probably some of the highest anxiety I've ever been through.” (Interviewee 003)

Due to the novelty of the COVID-19 mass vaccination clinics, role preparation was challenging. Toward the beginning of the mass vaccination effort, participants experienced the chaotic nature of the clinic environment with little formal training and preparation opportunities.

“It was chaos because it was the start of the pandemic… We all did our best. The readings helped but doing it in practice was where I got most of my real training done.” (Interviewee 008)

Participants mentioned public health authorities provided virtual training materials. They also said there was no checklist of training documents, videos, and activities to review. In addition, most of the training occurred on the job, with participants drawing on their previous clinical and administrative experiences to succeed in their roles. Clinic supervisor participants felt they had insufficient training resources and preparation to lead the mass vaccination clinics.

“There was no training at all. None. If I were to give feedback to public health, [I would say] there was a significant gap as there were no resources provided to clinic supervisors or managers.” (Interviewee 003)

In addition, scope definition presented a significant challenge with clinic staff contributing their skills in different roles as needed versus in a planned manner.

“I think the biggest challenge or the thing that we didn't do well was that scope definition. I think everybody stepped up and did what needed to be done to get it done.” (Interviewee 006)

Clinic System Silos

When examining the participants’ clinic experiences from a systems perspective, clinic supervisors expressed that the mass vaccination clinics operated in silos, despite similar objectives.

“We're very siloed. We ran our clinic separately from the [other clinics]. It wasn't very cohesive.” (Interviewee 003)

The participants revealed limited communication between clinic supervisors, managers and Public Health authorities, especially in the first few months of clinic operations. The lack of clear direction was particularly prominent in the mobile clinics where the timing of planning and implementation coincided:

“With the mobile clinics, pretty much all of it beyond the actual immunizing was unclear. It was being planned while it was being implemented, so there was not a lot of experienced staff behind it.” (Interviewee 009)

“We had to set up our own emergency response [for the mobile clinic]. We had to create our own policy code because that was not provided. We had to order our own epinephrine and blood pressure cuff. We weren't even provided with that.” (Interviewee 003)

Adaptable and Supportive Clinic Environment

The staff coped with the unpredictable and challenging environment through adaptability, dispositional flexibility, and fostering a supportive work environment.

Staff Adaptability

The clinic staff willingly adapted to changing circumstances as the pandemic progressed. Clinic staff participants reflected on learning new information about the vaccines and clinic processes, which enabled them to operate efficiently in a coordinated manner even when circumstances changed.

“We definitely learned as we went, but the circumstances have changed so much.” (Interviewee 009)

Over time, clinic staff became familiar with clinic processes and found it easier to adapt to changes. For example, these changes were often communicated through team huddles, allowing all clinic staff to align with changing roles and expectations.

“We have a quick huddle… Just a heads up for things that shift whether it was needle changes or just interval changes or population expectations for that day, etc.” (Interviewee 004)

Further, adaptability regarding staff schedules was another critical component in the success of the mass vaccine clinics. Considering changing clinic circumstances, clinic staff participants emphasized the importance of taking time to recharge. Clinic staff were also allowed to change their schedules as needed, contributing to an accommodating and supportive work environment.

“Knowing that I can change my schedule is nice… I don’t have to worry about letting them know that’s going to happen.” (Interviewee 001)

Dispositional Flexibility

Dispositional flexibility referred to how the clinic staff simultaneously acknowledged challenging situations yet saw these as an opportunity to improve. The pandemic created a unique environment where typical public health clinic flow would not apply. Participants reflected on the thought they put into clinic flow design to accommodate changing demographics of eligible clients; for example, ensuring that children, who were only eligible for the Pfizer-BioNTech Comirnaty COVID-19 vaccine, did not mistakenly receive a dose of the Moderna SpikeVax COVID-19 vaccine.

“We had to put in a fail-safe so that no one could get Moderna instead of Pfizer when they were 14 years old… We would only have certain rows who could do the 11 to 18’s.” (Interviewee 007).

This flexibility was also demonstrated in the participants’ views of the dynamic nature of the COVID-19 mass vaccination clinics. Over time, they viewed the changes as beneficial and less disruptive rather than contributing to chaotic situations. Additionally, a common notion of continuous learning, “figuring it out as you go,” was strongly emphasized.

“I wouldn’t want to be on an airplane that’s being built while it’s taking off for flight. I think we did better than that. I think that our plane was built. We were just tuning it as we were flying.” (Interviewee 002)

“There was some training… but since the job didn't exist before, there was a lot of learning on the go and developing the role itself as everything progressed.” (Interviewee 007)

Contingency planning was essential to adapt to unexpected changes in clinic operations, such as technical failures and extreme weather events. For instance, clients would line up inside the clinic building instead of on the sidewalk in the case of rain or snow. Further, paper processes and technical support were contingencies put in place should the clinic experience issues with the Coronavirus disease of 2019 vaccines global access- Ontario (COVaxON), the COVID-19 vaccination management system in Ontario.

“We have good workarounds in place. Whenever [COVaxON] went down… we had contingencies built-in like paper processes and lots of super user support on the floor to help staff.” (Interviewee 004)

Similarly, as clinic operations progressed, clinic supervisors could create functional teams with well-defined roles and scope. They achieved this by developing policies and procedures for process issues, documentation, and training.

“We have a really well-oiled system now, right? Like without having an official checklist. We have this team now that has defined scope, and that was missing for most of this rollout.” (Interviewee 006)

Supportive Work Environment

Overall, all clinic staff participants reported a positive experience working in the COVID-19 mass vaccination clinics, owing to a supportive work environment. Contributing factors to a positive experience included supportive colleagues, management, and effective communication. Ultimately, this helped all clinic staff participants feel that their work was meaningful and valued by the people around them.

“Overall, I would say that it's been a positive experience working at the clinics. The staff have been very nice people to work with. Management is friendly. They do their best to communicate with us.” (Interviewee 009)

“Our clinic ran very well. We had a very strong team. We selected the right staff to help move people through.” (Interviewee 003)

Clinic staff valued having friendly supervisors who instilled confidence in their teams, achieved through clear communication about roles and responsibilities, as well as openness to providing support and accepting feedback. Effective communication between clinic supervisors and other staff strengthened team dynamics. Transparency and open communication with staff through huddles were greatly appreciated by clinic staff.

“It's honestly worked out really well here. Like everyone knows their responsibilities. My manager is amazing…” (Interviewee 005)

“We had this meeting to get ourselves organized and stuff… It made a big difference in terms of morale. And we have a lot of support.” (Interviewee 003)

Within the broader context of the pandemic, all clinic staff felt that their work was meaningful. Although working in the clinics was challenging and, at times, stressful, staff participants felt motivated and described their role as the “exit strategy for the pandemic.” (Interviewee 008)

“I often described the clinic as part of the exit strategy for the pandemic. And I think that feeling was the motivation I needed.” (Interviewee 008)

In this study, we explored clinic staff participants’ perspectives on the dynamics of vaccination clinics amidst the evolving COVID-19 pandemic. The unpredictable work environment described the unstable changes experienced by COVID-19 mass vaccination clinic staff. The challenges of clinic cohesion generated similar counterproductive circumstances under which the clinic staff worked. Nonetheless, individual and system-level adaptations led participants to observe the mass vaccination clinics as a largely successful, fulfilling, and rewarding experience.

Considering the challenges described in this paper, we draw some key lessons. First, establishing a routine is a strategy to cope with a crisis. The quality of the work environment is a known predictor of the likelihood of teams achieving a common goal. The literature has highlighted how a stable routine with established roles and responsibilities enables the building of basic skill sets while simultaneously creating opportunities for building cohesion within teams [24, 25]. Participants working at mass vaccination clinics in this study found it difficult to quickly establish routine and stability owing to the unpredictable nature of the COVID-19 pandemic that continues to result in continuously changing vaccination protocols [26]. As a result, clinic staff roles also evolved, leaving staff unprepared and learning on the job in a busy environment. This feeling created stress points and, at times, led to suboptimal performance, similar to experiences reported in Canada during the H1N1 pandemic in 2009 [14]. Thus, while routine is essential, it is also critical to prepare healthcare staff for crises requiring additional flexibility while ensuring “routine” periods of recovery and stability.

A second lesson learned is that efforts to ensure clinics are adequately staffed can also stretch a limited pool of staff members across too many shifts, which can contribute to feelings of overwork. Staff redundancy and burnout were reported in our study, which is known to negatively impact staff motivation and productivity [27–29]. At the start of the immunization campaign, the uncertainty around supply and demand led clinics to be overstaffed at times, creating inefficiency. Later, as the vaccine supply increased, staff were scheduled for more shifts which led to feelings of overwork. Certainty and flexible work schedules boost staff motivation and increase productivity [31, 32]. In times of low demand, time can be effectively used to provide staff with preparation or refresher training for the diverse roles they might play during the vaccination period and for team-building activities [33, 34]. In other studies, [35, 36] it has been found that during pandemic periods, staff are often assigned emergent roles for which they are less prepared, as also noted in this study. Inclusive and adaptive planning of clinics can play a crucial role in creating more desirable work environments and increasing the effective use of resources, especially in the context of a pandemic [37].

A third lesson learned is the importance of immunization campaign planners and leadership being actively present in the clinics when designing operations and developing procedures. As highlighted elsewhere, engaged leaders can better gather and respond to clinic staff input and navigate both top-down and bottom-up planning approaches [38, 39]. For example, embedded leadership may be better positioned to identify the challenges outlined in this study, such as staff role disparities, limited job preparation and clinic system silos.

Fourth, staffing disparities arising from unclear staff roles, pay inequities and workload-to-staff mismatch limited clinic staff team cohesion. Clarity of staff roles is essential in streamlining organizational operations, increasing staff role satisfaction, and creating team cohesiveness [40]. Fair payment of staff is a known motivation factor; paying attention to differences in pay for the same jobs is critical in ensuring sustained motivation of mass vaccination clinic staff [41, 42]. Further, matching the number of staff to the workload available helps to reduce resentment among staff, as seen in our study.

Fifth, the benefits of adequate preparation of clinic staff are well established [30, 31, 43–45] Limited job preparation amidst the rapid deployment of an immunization campaign, especially during a pandemic, can be expected. Thus, in a pandemic, training should be anticipated as “learning on the job” as much as possible. Learning by doing is a well-established capacity-building approach [45, 46]. Even in a crisis, active learning should be deliberately designed to include specific phases of reflection and education to achieve its intended outcomes better. When clinic staff feel less competent, it affects their confidence leading to increased stress, anxiety and reduced performance. In contrast, more confidence does lead to improved staff well-being and work outputs [47–50].

Sixth, clinic system silos limit the extent to which cross-training can be achieved, leading to challenges in providing support as nuanced clinic operations and procedures must be learned. Creating a well-coordinated system to enable learning across clinics becomes essential in a pandemic situation. The benefits of peer-to-peer learning are well documented and include increased resource efficiency and effectiveness [51, 52].

Lastly, an adaptable work environment cannot be overemphasized in pandemic emergencies to counter what we found in this study as unpredictable work environments and challenges to team cohesion [53]. For example, providing staff with greater control over their schedules eased frustrations and contributed to more team cohesion in this study. Such an environment allowed for team problem-solving and improved processes and vaccination capacity. Therefore, clinic staff must be prepared for such unpredictable environments and equipped with the necessary skills to achieve resilience [43, 54, 55]. Increased resilience displayed by staff may contribute to increased public confidence in response teams during emergencies. Similarly, as demonstrated in this study, having a supportive, friendly work environment amidst a crisis benefits staff well-being. It ultimately contributes to a sense of meaningfulness drawn from the work undertaken, contributing to greater productivity.

Pandemics, especially in the context of COVID-19, have required public health to coordinate flying and building a plane simultaneously—a seemingly impossible task. Yet, in many locations, immunization clinics have succeeded in their efforts to provide vaccinations to communities en masse. Clinic staff participant feedback reveals that better predicting of clinic operations and staff schedules, or a transparent acknowledgement that these are a work in progress and suggestions for improvement are valued, is desirable for the successful operation of mass clinic vaccination clinics. Similarly, the reduction of staff role disparities is key to increasing staff satisfaction and productivity. Creating this through an inclusive, forward-thinking, yet adaptive planning mechanism can create more positive experiences for clinic staff. To improve team cohesion, role definition and preparation should be planned, and opportunities of low demand should be used to increase competencies among staff for different roles. Team cohesion can also be supported through more inclusive work schedules and by encouraging participation in team-building activities. Harnessing diversity by promoting peer-peer learning contributes to increased resource efficiency and effectiveness. An adaptable and supportive clinic environment played a crucial role in countering the challenges of running dynamic mass COVID-19 clinics in the Region of Waterloo. Preparing clinic staff with essential skills for adaptability is critical, and we recommend that it is included as part of hiring criteria and on-the-job training.

Lastly, some of the lessons drawn from this study were highlighted by a study undertaken during the H1N1 pandemic in 2009 [14]. Evidence from real-world pandemic experiences must be shared with public health authorities and policy decision-makers to improve our implementation management if a crisis arises again.

Ethics approval and consent to participate

Ethics clearance was received from a University of Waterloo Research Ethics Committee, the Region of Waterloo Public Health and Emergency Services and the Tri-Hospital Research Ethics Review Boards (approval #43288). Informed written consent was obtained from all interviewees.

Consent for publication

Informed written consent was obtained from all interviewees for anonymous use of quotes and publication of findings from this study.

Availability of data and materials

Transcripts of the interview are available upon request to the corresponding author.

Competing interests

All authors declare no conflict of interest

Funding

We are grateful to the Region of Waterloo and the Public Health Agency of Canada for funding this study. Grant number 2122 HQ-000330

Authors' contributions

MT conceptualized the study, was involved in data collection and led data analysis and draft manuscript writing. RT was involved in data collection, data analysis and draft manuscript writing. MA and AB were involved in the data analysis process. NW, CB and KG were involved in the study conceptualization and data analysis process, they also provided guidance during manuscript drafting. Additionally, KG provided overall technical guidance and leadership to the implementation of the study.

Acknowledgements

We acknowledge and appreciate the study interviewees for sharing their invaluable insights and experiences that made this study possible.

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published 03 Oct, 2023

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Reviewers agreed at journal
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13 May, 2023
Editor assigned by journal
16 Dec, 2022
First submitted to journal
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You are reading this latest preprint version

“Flying a plane and building it at the same time”: Lessons learned from the dynamic implementation of mass vaccination clinics in the Region of Waterloo, Ontario, Canada

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Journal Publication

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Abstract

Background

Methods

Results

Conclusions

Figures

BACKGROUND

METHODS

Study design, selection of participants, and data collection technique

Data analysis

RESULTS

Unpredictable Work Environment

Changing Clinic Processes

Impact of Clinic Adjustments

Clinic Cohesion Challenges

Staff Role Disparities

Limited Job Preparation

Clinic System Silos

Adaptable and Supportive Clinic Environment

Staff Adaptability

Dispositional Flexibility

Supportive Work Environment

DISCUSSION

Conclusion And Recommendations

Declarations

References

Status:

Journal Publication

Version 1