Behind the scenes: How a vaccine clinic went from sequential flow to circles.

Google “Evolution” and you will get a biological definition as such: evolution is the change in the characteristics of a species over several generations and relies on the process of natural selection. However, this article is not on the theory of evolution. Rather it is a first-hand story into the inner workings of the design team at a hospital network in Toronto, Canada. This team persevered to evolve a covid vaccination clinic from the classic three-step process of “registration-vaccination-observation” into something unique. This all stemmed from their aspiration to improve the delivery of vaccines and create a pleasant experience for all.

Here is their story to date…in 3 simple phases…


As with all ideas, they usually take some time to grow and develop into something remarkable! This story is similar and it starts in December 2020 — a group of consultants sitting in a design room, throwing whatever comes to mind on the board with the hope to connect and build on each other’s ideas. The result? After a few days of “percolation” (not sure if that’s even a word), there is a set of solutions ready to be tested in the field of the unknown! Yes, this does sound like an oversimplification, but the fact of the matter is ideas are often discovered from a simple spark that ignites the imagination — one spark to another until you see the final product.

However, knowing that they were in the midst of a mass vaccine rollout, and that mass vaccination comes with its own complexity of dealing with a diverse population; the team at the hospital wanted to develop a clinic to help not just Torontonians, but be scalable and implemented globally. Their goal? As Roger Martin intended in his highly-praised book: the Opposable Mind; applying integrative thinking to balance both the experiences of staff and patients, without compromise. As a result, the team was inspired by some very unusual sources 1) the Grand Mosque in Mecca, 2) Formula1 racing, and 3) Restaurants. They added these in a percolator — gave it some time — voila, three unique designs were born!

Phase 2: The PITCH

Ask any salesperson to give you the keys to the ultimate sales pitch (the Sales 101 sort of speak), their answer: don’t tell the customer, show the customer! This approach is similar in the corporate arena as well. Before the design team at the hospital could implement their final design, alternative designs needed complete team support.

Why? Because they overcomplicate things! And that is what happened when the first pitch was made; it ended up being “this idea is too risky — let’s stick to the simple three-step process.” Just like that, the most efficient setup (hint: the title of this article gives it away) was put on the back burner, never to be mentioned again!

Back to the design room… Here lies the problem with idea pitches. No one likes to be sold, they like to decide on their own so give the ownership back to the customer (in this case, the vaccine team). Take two…if you have ever watched Dr. Seuss’: The Lorax, the movie ends with a perfect motivational quote for any designer:

This time around the pitch was made with the so-called “risky” idea presented again after months of percolation in planning sessions, one-on-one chats, casual walk discussions, and offline meetings — the team was ready to try it out! A surprised design team looked on while the “mad scientist” cooked up the ultimate flow model. Meanwhile, somewhere down the road in Downtown Toronto, other teams aimed to break the world record for most vaccines in a day! However, this team was focused on the ultimate set-up where even the least-resourced teams around the world could use the model for their vaccine efforts. Lesson learned? No idea should be presented as complete — give the audience the ability to mold it and they will (fingers crossed) agree to test it.


Ahhh! The feeling of achievement of any designer is when their work is taken off the computer screen and into action. Let’s rewind to January 2021, when the team implemented D1 — a classic setup of patients moving from one station to another (i.e. registration, to vaccination, and finally observation) — this is something you may have seen or even experienced at your own vaccine site. Further recall, these designs were being tested by people with training in engineering so naturally, they want to know — are we good? or do we need to do better? They needed to do better. The issue with D1 was its resource-intensive nature created long lineups between stations and made it highly dependent on space availability. The less post-vaccination observation space you have the lower the capacity of the system (i.e. the number of shots you can give in typical clinic hours).

To fight the virus you need vaccines (obviously), but you also need to be able to fit as many chairs as possible because more chairs equate to more people getting vaccines today versus waiting tomorrow or a week!

Fast forward to May 6th, 2021 to usher in D2. Why should the patient move when the process of registration and vaccination could come to them? D2 has many names — the most common are “hockey hub” or “cart model”, whereby carts bring vaccines to the patient while they wait in grid-style chairs setup. The benefit? A quicker vaccination rate at the beginning but as the day goes on fatigue dominates the vaccinator, which impacts the use of the hottest commodity. The team ran this model in clinics and during mobile visits — it showed great promise but with a 2.2 to 2.5x hourly chair turn rate, (i.e. a patient may occupy a chair longer than your fastest vaccinator or what we call wasting the most expensive resource in the clinic — the Vaccinator’s time!) the team needed to do even better!

Digging deeper into the challenge, it was realized that grid-style chairs lead to no value to the customer when the carts are being pushed up the aisle — an extralong walk with no customer interaction. Furthermore, safely distanced chairs in a grid formation such as a rectangular or square layout occupy more space than needed, while circles (considered the king of geometrical shapes — don’t quote me on this) check all boxes and naturally fit into the evolutionary process. From D1 (classic) to D2 (carts) and finally now to D3 (circles) — the once “risky” design was here to stay!

The day was July 9th, 2021 when the circles turned like no clinic has ever turned in the city with a turn rate of 3x per hour! Staff feeling a sense of relief from reduced walking (fatigue erased from their vocabulary…a bit). Patients feeling relaxed with fellow vaccine “lovers” sitting around each other rolling up their sleeves for the jab. As a bonus, a model was born with scalability and a sense of community. Have limited space? Keep it to one circle only. Have clients who need more support? That is, first shot, language barrier, accessibility need — set up a smaller separate circle that meets the need. Have a baseball stadium? Set-up pods with three concentric circles — the possibilities are limitless!


As the world accelerates its vaccination efforts, I thought I’d share some of my learning working closely with the vaccination team at Scarborough Health Network in Toronto, Canada. Reach out if you would like to learn more or drop a comment if you found this helpful.