Quebec solves H1N1 vaccination queues with Disneyland Fastpasses

Quebec has streamlined its H1N1 vaccination system by borrowing a trick from Disneyland's "Fastpass" queueing system. At Disneyland (and other Disney parks), busy rides have Fastpass ATMs at their queue-heads. Would-be riders insert their park-tickets and get a reservation stub in return, advising them to return later in the day in a one hour window (say, 1:15-2:15) (pro tip: Disney doesn't enforce the "expiry" time, only the "ripening" time, so you can go any time after 1:15, which means that you can collect Fastpasses all morning when the lines are short and use them all afternoon when the lines are long).

Quebec's health-care system is doing the same, banishing seven-plus-hour waits in favor of a quick, efficient system that allows people to return at a later time for very quick treatment.

Tony Benn, the great British politician, recently gave a CBC radio interview where he decried New Labour's approach to governance, saying that they'd stopped seeing themselves as the people's representatives and started seeing themselves as the people's managers. This is true around the world, I think -- Bush was the "CEO President" and Obama has appointed a "CTO" for America. Canada's Harper government clearly sees itself as running Canada, Inc. And, of course, China and Singapore's politburos are unabashed managers and make no real pretence to representing their populations.

And there are some benefits to a "management" approach -- this being one of them. Disney manages crowds like no one else. If you have crowds that need managing, take a notebook and a camera to Disney World for a week and come back with the solution to your problem.

But in the main, I'm a lot happier to be represented than managed. A CTO tries to maximize the profitability of technological deployments for highest return on investment; a Minister (or Secretary) of Technology would maximize the social benefits of technological deployments. A CEO tries to return maximum value to his shareholders; a President or Prime Minister tries to govern for maximum social justice and prosperity.

Every now and again, though, "management" and "representation" dovetail, and here's one of those places where it does. I want my representatives to manage the problem of getting us all vaccinated, and I'm happy to see them use the best tools for doing that, wherever they originate.

Lines are still forming at some vaccination centres, where people are queuing up early just to get their coupons. But officials say the system has been effective. At one vaccination centre in Montreal's Plateau Mont Royal district recently, nurses and health workers outnumbered people in line.

"The system is marvellous," said Johanne Spencer, who'd whisked through her vaccination. "You know what time you're going to have your turn and you know how long you'll have to wait. You don't waste three, four hours in line."

Montreal adopted the coupon system for all 17 vaccination centres across the city.

"Something had to be done," said Deborah Bonney, a spokeswoman for the Montreal-region health and social service agency. "At the beginning, we had no idea people were going to line up in the dark of the early morning in the cold. Confronted with the situation, the coupon system seemed to be the best option. It seems to have done the trick."

Quebec's Disney-inspired solution to flu-shot chaos (Thanks, Mom!)

(Image: Con FastPass ya habrías entrado, a Creative Commons Attribution-ShareAlike photo from jmerelo's Flickr stream)

• [davedorr9]

  Although there are some good points about this being old technology, there are a number of excellent reasons to highlight this technique:

  1) Electronic scheduling of specific procedures, like a ‘flu shot’, solves some major issues regarding the supply vs. demand problems and the time-cost and frustration of waiting.
  2) aggregation of these systems is very slow in the US: the google api for flu shots is a great start, but it requires that the majority of people who receive supply actually post availability, which does not happen today.
  3) these kinds of issues should be the primary focus of improving our health system:
  – using electronic means to solve an otherwise frustrating problem elegantly.
  – demanding participation from any organization that provides health care with a public focus
  – setting interoperability guidelines based on high need issues like this one and enforcing them
  – holding our government and public health system accountable for fair and even distribution, but using our broader health system infrastructure to provide better access than public health clinics alone.

  Isn’t this kind of thing what the information age is all about?

• [Anonymous]

  Delis have been doing this for years.

• [RedMonkey]

  I’m not sure this exclusive to Quebec, they’ve been doing the same thing in Ontario since the vaccinations started. They hand out wristbands in numbered sets, and ask you to return when they approximate that the number they gave you will be called.

  And on the management/representation front, I’m not sure there has ever been a government that has focused entirely on representation without an eye to management, and if they ever did they would probably be incredibly ineffective having to ask “the people” every time they did something.

• [Anonymous]

  I don’t think the Disney FastPass system allows you to have more than one at a time for different rides. You can’t get a second one until the time for the first one has past.

• [IamInnocent]

  I’d still take a pass on the needle though ;)

• [Gloria]

  Um, is this really exclusive to Disney too? Museums and art galleries have long sold time-sensitive tickets, particularly for major exhibits. Patrons show up to enter at a particular time slot so line-ups can be minimized and volume within the galleries themselves are controlled.

  For example, the Galleria Borghese in Rome only permits about 260 people inside at all times. They only have three admission times and is VERY strict about its 2-hour visit policy — everyone is shooed out at specific times of the day, so you really need to show on time for your visit.

  Your “pro tip” is useful but not very considerate — if tons of people decided to do what you did, the system wouldn’t work.

• [Anonymous]

  The DMV (horror of horrors) in California has a similar system. You can make an appointment online instead of having to simply show up and waiting in a huge line.

• [efergus3]

  Ummmmm, one hour window? The top ticket shows a 30 minute window.

• [jmcgarry]

  Thanks for posting this Cory, I’ve passed on the link to my District Health Unit and asked if they can implement something similar.

  I’m not sure were you are @RedMonkey but that was not case where I am, wristbands came much, much later after a good deal of chaos.

• [Anonymous]

  I was at the Olympic stadium for the shots 12 days ago with the kids, my folks went there about 8 days ago and my neighbour went on friday.
  No lineups.
  They had to wait for us at one checkpoint because the kids had to pee.

  You do have to walk around a good deal but at least you are not seated in a tight, low ceiling clinic.

  Parking is free at the stadium and the metro drops you off right underneath the stadium. To get the kids mind off, you can either take them to the movie complex, the Biodome or the Olympic pool afterwards.

  Our friends who live in another postal code have to go to a clinic where you wait in line seated like sardines.
  We lucked out because the stadium is in our district.

  The organization has been very smooth from ‘what we saw’.
  Mileage may wary though depending where you live.

• [Anonymous]

  Pro tip is almost right. Disney generally doesn’t enforce the expiry time. But that doesn’t mean you can collect Fastpasses all morning. You can only have one Fastpass outstanding at a time. So if you get one for Indiana Jones for 1:15-2:15, you won’t be able to grab any more Fastpasses until 1:15.

• [Anonymous]

  Maybe I’m missing something, but how is this different from that old-fashioned line-management technique known as a reservation?

• [netsharc]

  I can’t help but think this is also solvable via a website which saves the initial trip, and it can also be completely anonymous.

  1. Person visits website and says he wants a shot, picks the times he prefers.
  [if person doesn't have a computer, terminals will be provided at vaccination stations]

  2. System checks that a particular time segment has still some capacity, slots that person in that time, with a number (say 181687).

  3. Person gets that number on his screen, and is told when to arrive at his vaccination station.

  4. Person does so, presents his number, and gets his shot.

  Of course with the addition of bureaucracy we’ll all be dead before such a system gets implemented. And the system relies on humans not being totally brain-dead.

  Come to think of it, either this system or a Fast-Pass one would also be useful to reduce the amount of queuing on election days… then Diebold can lose the numbers they gave out, and not let those D-voters in!

• [ian_b]

  This is why people fear socialized medicine. Here in America, you order a vaccine and it arrives at your house in 10 minutes, delivered by fighter jets and handed to you by football player. The vaccine itself is infused into your choice of a crisp, cold, Coca-Cola Classic or Starbucks Latte.

• [Anonymous]

  @johnlancia
  As I understand it, they are concerned about 3 things with H1N1–the demographic it is killing (the young and the pregnant instead of the old), the extremely efficient transmission, and the fact that H1N1 cases are spiking now, while seasonal flu doesn’t spike until January in North America. The 1918 flu “only” killed 5-10% of the infected, but infected just about everyone who came in contact with it.

  The big fear is that H1N1 cases will keep rising (or even just hold at the current level) and then the seasonal flu will kick in, really overwhelming hospitals. I know a 30-something (with no other risk factors) who just dropped dead (in the hospital) of H1N1 complications, and that is really unusual for the flu.

  If you don’t want a vaccine, don’t get one. But don’t knock the people who are–they have a different level of risk tolerance than you do, and they can help keep you uninfected as well.

• [EMJ]

  In Sweden some health care clinics have a similar system for phone calls. Instead of endlessly waiting once you have navigated a long menu, there is a menu with a few choices and then you get a recorded message: you will be called back between 10 and 11 am. Less waiting around, more efficient.

• [johnlancia]

  @ Anonymous#19:

  Sack up and stop hiding behind Anonymous.

  All flu has an extremely efficient transmission.
  Who cares if it is spiking just now if it has ‘only’ killed 0.018 percent of people it has infected. If you are worried about those odds, then stay away from your car and don’t go anywhere near bee’s or wasps. You have much better odds of being killed by them. As for the demographic. What the fuck is that supposed mean?! Elderly and infants die by the thousands every year, but this year its thirty somethings, so its Armageddon time. What is this? Logan’s Run? I fail to see how one is more important than the other unless we are worried about keeping the pension payments down as much as possible. Step back and think about what you are saying son. Or, more importantly, think about what the taking heads are saying to you on the boob toob.

  Yes, the 1918 flu killed 5 to 10 percent of those it came into contact with. But lets get some perspective on that statement. The Spanish Influenza was bred in the trenches of WWI Europe. Those mildly effected were kept at the front, those with the severe strain where shipped back behind lines and incubated in hospital wards in towns and cities. A true pandemic ensues. At the time, people did not even realize that washing their hands regularly would help prevent getting sick. Restaurants would routinely scrap food off of used plates and onto the plates of new customers. In short, that world is not our world.
  The Big Fear is what you are being fed. Talking heads pulling figures out of their asses saying that H1N1 fatalities will keep rising. Calling 4000 deaths in a country of 350 million a ‘pandemic’. You can get a pundit to say anything, about anything. Watching a half hour of Fox make that clear to anyone with a shred of free thought left.
  You know a thirty something who died of H1N1. That’s a terrible thing and I wouldn’t wish it on my worst enemy. I volunteered at a rest home when I was younger, and every year, one or two, sometimes three people who happened to be seniors, died from the regular flu. I was told that this happened every year and probably at every rest home. Not to mention those who succumbed to it in the outside world, as well as the children. Thankfully I’ve never known a child who has been killed by it. Yet where is the media outcry?
  I have nothing against getting a vaccine for this. If you are at risk of getting it, then you probably should. What I take issue with, is the way that everyone is being worked into a lather about it by the media and government, and the way it is being handled. No doses at your family doctor, doses are packed together in multi-dose vials increasing the risk of them going bad and having to be discarded. Also, you all have to come to the same place and line up for hours waiting for your turn. You know, with the other people who are susceptible to H1N1.

  • [phenocopy]

    Just to be clear, 2009 H1N1 IS a pandemic.
    Pandemic has nothing to do with mortality or morbidity, but with geographic and temporal spread. We in the US are having an influenza epidemic (more people than expected infected in an isolated area or single country), but this is also an influenza pandemic (infections on several continents at one time).

    Not all flu has efficient transmission. But yes, thousands of people die from “regular” seasonal influenza every year, and nobody blinks. For some reason, people start to get worked up when children die. (It reminds me of living in NYC- every time a kid died the newspapers would have headlines about the “angels” that were lost.)

  • [Gloria]

    “Watching a half hour of Fox make that clear to anyone with a shred of free thought left.”

    Dude, that’s why you’re so outraged about this. Fox is crazy about *everything.* If it wasn’t H1N1, they’d whip up a report of how rickety stairs are murdering the country’s seniors. “Your grandmother could be using stairs RIGHT NOW!”

    “What I take issue with, is the way that everyone is being worked into a lather about it by the media and government, and the way it is being handled.”

    No one *here* is worked in a “lather.” If you have a problem with crappy journalism, write a letter to the editor or the broadcaster. Some of us have actually gone out and read the literature, evaluated the risk, and for whatever number of reasons, still think we might need a vaccine; no need to assume we’re drooling, slack-jawed morons glued to our boob tubes.

• [El Stinko]

  I know this is entirely beside the point, but at Disney you can only get one Fastpass at a time per card. So you can’t just go around and scoop up spots on every ride at once.

• [sej]

  Just wanted to chime in that this is how I got my H1N1 vaccine two weeks ago in British Columbia. Saved a lot of kids and people with compromised immune systems from standing out in the rain and cold for hours. Way to be awesome, Canada.

• [mgfarrelly]

  It’s a great idea. Anything that makes healthcare more accessible is a fine thing.

  I agree with you Cory about the idea of being “represented/managed”. As an American, I don’t want a CEO/CTO President. A nation is not a profit-generating enterprise. Quite the opposite. The ideal, as I see it, is being able to do the most good for the most people while maintaining our core principles and breaking even at the end of the day.

  Brand Americe should be a non-profit.

• [Cory Doctorow]

  @El Stinko: No. You can only get one FastPass per hour.

  • [mark]

    Actually the last time I was there, this past July, they were allowing two passes in their ‘ripening’ period per ticket/person/card. That said, I can’t see a practical reason why they wouldn’t adjust the system depending on park attendance and ride uptime. The permanent signage they had up did not spell out the specifics of those limits when I was there, only the digital signs.

• [Hypnoid]

  Phenocopy’s comment #24 is bang on.
  Mortality rates are fairly irrelevant without considering prevalence rates. H1N1 has a low mortality rate, but I’m willing to bet that it will kill a lot more people in my city this year than, say, pneumonic anthrax. Or smallpox. A case fatality rate of 0.2% still makes a large number of fatal cases if you infect a million people or so.
  It’s also worth noting that H1N1 has greater potential to disrupt healthcare in general than seasonal flu does. In a normal year the typical patient seriously ill with influenza is chronically ill and elderly. When they become badly ill there isn’t always much you can do for them which realistically is going to work, and they may die quickly. If you’re a 30 year old healthy pregnant woman seriously ill with H1N1, chances are you’re a candidate for every treatment available.Currently 1/3 of our ICU beds are occupied by H1N1 cases, and my intensivist colleagues tell me their care is very complex and taxing. It wouldn’t take that much more serious a pathogen to really mess things up for anyone seriously ill with anything-if every ventilator is occupied, and every ICU nurse is exhausted, you probably don’t want to be heading for that hospital after your major trauma or your cardiac arrest…

• [schmod]

  @netscharc: You then have the issue of making sure that each person actually arrives at their requested timeslot. I imagine you’d have a lot of no-shows under the system you propose.

  Of course, if you took a small deposit, that phenomenon would go away completely, though the logistics and ethics of doing so would be extremely questionable.

• [Notary Sojac]

  I would rather we see politicians not as “managers” or “representatives” but as the “mildly learning impaired hired help”.

• [Anonymous]

  the Vets Hospital in Minneapolis went to this system after
  the last big flu scare had guys,some very old,standing in long lines in the hallways.i get my shot at my evening clinic when i go in for med re-fills but for a walk in the Vets just go to a desk and check in,get a timed number and then can go to the PX or hang around and BS as Vets will do.

• [Nadreck]

  Several of the Public Health Units here in Ontario have moved to this scheme. Nothing, really, to do with Disney though: I’m sure that this was the system used when the Sphinx opened – only with scrolls and trumpets.

  Unfortunately, here in Toronto, our local, incompetent Public Health Unit has done no planning at all and the distribution process is pure chaos. At the federal level, there are no plans of any kind in place to deal with pandemics. Your guess would be as good as anyone’s as to who’d take the operational lead or be the spokespersons during such a crisis. The dozen or so agencies involved will just make things up as they go along.

  This is despite the almost decade-long headstart they should have had after the near-miss of the SARS episode.

  This being Canada, there will be no consequences of any kind for one single individual for this level of willful, reckless negligence regardless of how many people die. See the Walkerton water supply poisoning case, the Hepatitis C scandal, the tactical nuke level natural gas explosion in North York, the Alan Smith coroner scandal, ad nauseum, ad infinitum.

• [uglyredhonda]

  With the Disney FastPass, it’s actually that you can’t get another FastPass until the time stamped on the last one you took or for two hours, whichever comes first. Usually, the wait time on a FastPass is an hour, but with the popular attractions (eg, Soarin’, Toy Story Mania), it’s not uncommon for so many FastPasses to have been distributed that the stamped time is two hours or more away.

  So, yeah, to Cory’s point – if you collected FastPasses early in the day (grab a FastPass, wait in the standby line and ride it anyway, grab another FastPass after an hour, etc), you could theoretically stock up for a few rides later in the day.

  It’s cheating a little bit – you’re potentially denying someone else from being able to get a reasonably-timed FastPass later in the afternoon (especially on the rides that “run out” of FastPasses). But I assume if the practice really became widespread, they’d start enforcing the time windows.

  /yeah, i know – long, boring, no one cares

  • [technogeek]

    For what it’s worth, the easy way to buck the lines at Disney is to go there when you are wheelchair-bound, or when someone in your group is. Apparently they bend over backward to make sure their rides are not only Accessible, but accessed. Personally, I consider that a Good Thing; I’m willing to stand in line one more minute to give someone who’s been having a hard time an extra shot at a smile.

• [johnlancia]

  Why get so worked up about this?!
  H1N1 has killed 0.018 percent of the people it has infected in the U.S. (roughly 4000 killed so far). This is nothing to sneeze at of course, but the regular flu does more damage every winter.

  Here’s one article on it. Once you get past the usual fear mongering and such, you get to the numbers:

  news.discovery.com/human/cdc-swine-flu-numbers.html

  From the article:

  Some 98,000 people have been hospitalized from this new flu or its complications, including 36,000 children, 53,000 adults younger than 65 and 9,000 older adults.

  In a typical winter, seasonal flu strains cause 200,000 U.S. hospitalizations and 36,000 deaths, the vast majority in people over 65.

  Swine flu is as deadly now as it was in the seventies, which is to say, not very. Where is the big media shit storm about the regular flu every year?
  In my opinion, when media and government get together and try to sell you something as hard as they’ve been selling this, its to distract you from something. Like high unemployment, your rights being stolen from underneath you, meaningless wars, high gas prices, high interest rates, or all of the above plus some.

  • [Gloria]

    “In my opinion, when media and government get together and try to sell you something as hard as they’ve been selling this, its to distract you from something. Like high unemployment, your rights being stolen from underneath you, meaningless wars, high gas prices, high interest rates, or all of the above plus some.”

    Considering the amount of sense in the average panicking mother saying that government mismanagement was approaching a “Katrina-level of chaos” (no joke, this is a real thing uttered by a real person), why bother with a PR/logistics nightmare like a flu pandemic? Surely something shiny would suffice.