Wednesday, June 28, 2017

Revolution (Musings on how e-mail destroys work lives)

Updated: 4 July 2017
June 29, 2007, Steve Jobs introduced a revolutionary gadget 

June's blog had a long gestation. Perhaps it's a baby elephant as it's been in the womb for more than a year and a half.  Why so long? Likely because I've hesitated to 'give birth to a child' who may be unwelcome. But I'm hoping readers can accept the latest baby-blog in the spirit in which it was created.

Bear with me as I explain the experiences that caused me to write the blog before getting to the nitty-gritty content.

In brief, I've been a user of personal computers from the get-go. My first PC was the PC Jr using command-driven MS-DOS software (Aargh!). 

Also was an early adopter of the Internet when it came to Canada, mainly because of the exciting potential to communicate with colleagues around the globe. In those prehistoric times terms like archie, ftp, html, telnet, usenet groups, and veronica ruled. Indeed, to create my first website, I learned how to code html from a textbook. Then...DRUM ROLL....
  • 1984: Steve Jobs introduced the first Macintosh with GASP! a graphical user interface (GUI) and mouse;
  • 1986: Eric Thomas invented listserv software for mailing lists and commercialized it as LSOFT in 1994;
  • 1989: Tim Berners-Lee invented the World Wide Web;
  • 1995: Bill Gates' Microsoft introduced its GUI OS, Windows 95. 
And, all of a sudden, the Internet was off and rolling, Bigly (as US President Trump might say). A revolution in communication whose evolution is far from over. 

Pricing tidbits: After using computers run on MS DOS, I became a 'Macaholic' for years, although Macs were truly expensive in the early years. For example, in 1988 bought a Mac SE with basic software for $5595, 4 MB memory upgrade in 1990 for $660, and 40 MB hard drive in 1989 for $1300. In 1991 got a MaC LC with basic software for a whopping $8111, on a line of credit. Yikes! 

Of course, once Windows 95 appeared due to consulting contracts, I ultimately was forced back to the MS dark side.

Over decades of observing how folks communicate on the Internet including running mailing lists for med lab professionals, writing blogs, and corresponding with colleagues around the globe, I'd like to say a few things about e-mail. The blog is not strictly a transfusion-related blog, but I hope transfusion professionals everywhere will be able to relate to its musings on communication.

Executive version: The blog's content offers tidbits for how to communicate more effectively via e-mail, but I'm under no illusion that readers will take them to heart. Perhaps agree in principle to the ideas but, without executing them, ideas are worth nothing. And old habits are hard to break.

The blog may (or may not) be the first in a series of tips involving other communication such as presentations and scientific writing. I'll play it by ear.

Much has been written on e-mail and many valuable resources exist. Hence, I do not intend to re-invent the wheel or to be all inclusive. What follows are just a few musings on things that bug me most.

The blog's title comes from a 1968 Beatles ditty.

Most professionals with job-related e-mail accounts know that it's over-used and abused and a major consumer of valuable work time. Indeed, much e-mail is a total waste of time (Further Reading).

Seems obvious, but for each message sent, do you first decide whether e-mail is the most effective way to communicate whatever it is you want to communicate. Before sending a message or responding to one, do you ask if it's truly necessary and the best way to achieve its purpose? Likely not. Today e-mail is an automatic response to communicating.

Yes, e-mail is the easiest way to communicate but may be a poor, even horrid, way for a given objective. Plus e-mail has the dreadful disadvantage of being easy to misinterpret. For one thing we cannot see the sender's facial expression, the smile and twinkle in the eyes. Words said even warmly can come across as blunt and harsh.

FACT: E-mail has run wild with little to no purpose for a long time So many e-mails about so little clog staff in-boxes and take away precious time from the real work of providing patient care, ensuring safe transfusion.

Bet you all know a TM professional (lab technologist, nurse, or physician) whose in-box bulges with 100s of e-mails read once but not yet dealt with. Or on return from vacation, even more in-box clutter? 

Abuse like that forces staff to read work e-mail when on holidays, destroying the entire aim of getting away from work pressure.  Executives and managers abuse staff this way and get away with it. Ultimately the buck stops with employers who do nothing to stop the practice and may even encourage it.

And you know what? I bet that, if the 100s of e-mails were never read, the universe would still unfold as it should.

In this section I concentrate on a few things that bug me most about writing e-mail messages. From experience, I believe that many lab professionals, regardless of age (including those who have known e-mail, social media, the Internet all their lives) do not know how to write and respond to e-mails effectively.

Why keep the purpose of an e-mail message a secret, as so many do? For most job-related e-mail and correspondence with colleagues, it's critical to convey the purpose and any action required 'above the fold' (newspaper parlance).

Nothing is worse than wading through an e-mail to find the key bit at the end. It's abusive of the reader's time and reminds me of the typical telemarketing call:

  • You answer, hear nothing but background noise. 
  • After a few seconds that seem an eternity, someone asks you something like, 'How are you today?' 
  • My response, sometimes said aloud, is 'What the hell do you want? I'm busy.' 
  • Or what a pal typically says forcefully but more politely: 'What do you want?'
Learning point: When writing e-mails, specify the purpose and say what you want recipients to do up front, above the fold. Don't keep it a frigging SECRET.

FACT: Today most professionals are so overwhelmed with  e-mail that they typically scan messages with almost none of it being processed in their brains. This makes it critical to get their attention immediately. Also, using all-caps headings can help to focus the mind.

Examples of what to write above the fold include

  • No response required, for information only. Read now (it's time-sensitive) and file;
  • Your immediate response  to a question is required below. Please do NOT 'reply to all';
  • Please confirm receipt. It's FYI only but important enough that I need to know that you received the message. Replying 'Got it' suffices. 
Vague Subject Lines that tell the receiver next to nil about the e-mail's content are another gripe.

First, to have any value, Subject Lines of messages to individuals and to mailing lists must be precise and descriptive. As a long time manager of mailing lists, most subscribers have learned to draft useful Subject lines. But I'm always surprised that some continue to use Subject Lines such as 'Question'. Not very informative to readers and makes list archives useless if not revised by the list moderator.

Second, with a series of e-mails on the same topic between even two persons, keeping the original Subject Line for multiple messages in a conversation is not helpful. Multiple messages with identical Subject lines don't give a clue as to which ones contain the specific info people may want to refer to later.

Learning point: Make Subject Lines as useful as possible to the receiver. Think about the TV shows you want to view. Would Sports Contest, Police Drama, or Reality TV be useful listings on your cable TV guide?

Short paragraphs in e-mails are as important as they are on web pages or in any writing (annual reports, even novels).

But to write in paragraphs, you need to know what they are. Are such basics even taught anymore in the age of texting? (Further Reading)

Learning point: With e-mails I recommend that writers break information into short paragraphs even if they deal with an over-arching theme, but have a discernible sub-topic. When reading long paragraphs, eyes invariably glaze over.

Some colleagues. and administrative assistants in university faculties and hospitals include everyone in the visible Cc field as opposed to the blind carbon copy (Bcc) field.

An easy alternative is to use your address (sender's address) in the To: field and put recipients in the Bcc field. That way privacy is protected, including if any recipient decides to forward the message to others beyond the intended recipients.

Added benefits of the Bcc field: 

  • If someone goofs and replies by hitting 'reply to all', the message will not go to those in the Bcc field; 
  • It's an anti-spam device. Should someone's computer be infected with a virus that harvests e-mail addresses, addresses in the Bcc field are protected. 
Learning points: Many people do not want their e-mail address to be distributed to people they do not know. And what folks write to you is for your eyes only. How else can they be honest?

Most experts say to limit reading e-mails to set times of the day, perhaps once in the morning and once in the afternoon. But I know of few who have the insight and guts to do it. There's always the fear that you may miss something, a silly fear because most e-mail is an unimportant waste of time.

Research shows that when you interrupt your work with a distraction such as e-mail, it takes much time to recover and re-focus on important tasks at hand. Yet folks do it constantly throughout the work day. E-mail gobbles up so much staff time it borders on the criminal, meaning it does real harm to an organization's productivity.

Learning point: Why not try being the boss of e-mail versus being its poodle? Breaking free not only involves reading e-mail perhaps twice a day but also dealing with messages at the time of first reading. Reading messages and keeping them so that you need to read them again at a later date is an insane waste of time.

It's similar to quitting smoking. You're the boss - you can choose NOT to smoke. I made the choice 30 years ago after being a nicotine-addicted chain smoker. You can choose to be the boss of your e-mail. It's within your power, albeit not easy. New life-changing habits take much effort.
Tips on e-mail and mailing list etiquette are all over the Internet. Many years ago I wrote guidelines for MEDLAB-L (Further Reading). For this blog I'll only offer a few tidbits:

 1) As a general rule do not share personal e-mails without the sender's permission. While it's true that once anyone sends an e-mail, they never know where it will end up, But respect the sender's privacy as you would want yours to be respected. Do not share without permission, unless there's a compelling reason to do so, such as you think you are being abused and need to discuss it with others.

2) Never send an e-mail in anger or with a flippant response and especially not after midnight. Give it a day or two to reflect upon.

3) When you e-mail a colleague for help or advice on any topic, once they reply, have the courtesy to say thanks. That way they know you received the reply and, more importantly, appreciated them taking the time and effort to help. I can't count the times I've spent hours assisting folks with a request (some I know but many who are strangers) to never hear from them again. Some experts say to axe the thanks (just more in box clutter) but to me it's common human courtesy and let's folks know you got the reply.

4) Because e-mail is such an impersonal medium and open to misinterpretation, take the time to personalize messages as if you were talking to the recipient in person. Again, some experts recommend cutting the niceties because they're superfluous time wasters. But to me, the personal touch is essential.

5) Keep e-mails short and, as noted earlier, consider using headers to focus the recipient's attention. Involves editing original for brevity (as you would with Twitter's 140 characters), but more importantly, deciding what is fluff that adds nil to the e-mail's key message.

However, do not sacrifice the personal touch for brevity. Connect with colleagues and encourage them to see you as a real person with shared experiences they can relate to.

6) Proofread e-mails as you would scientific papers submitted for publication. E-mail messages reflect on you.

Learning point: See e-mail as a communication medium with an etiquette similar to talking face-to-face. The key point is to respect colleagues as you would want them to respect you.

The Internet is a revolution that changed everything, which is why I chose Revolution for the blog's title. So many good outcomes and some not so good. On balance, to me life before e-mail was better than life after. Why? Because today time for professionals to reflect is limited. Yep, we can communicate worldwide but at what cost?

Professionals are now slaves to mostly useless e-mail. With multi-tasking 24 hrs a day, no one has time to reflect. It's hours of mindless skimming of e-mail messages that did not exist before. Non-productive, non-efficient wasted time at workplaces, abuses staff time at home and on holidays, and contributes nil to patient safety. 

As always, comments are most welcome whether you disagree with me or would like to add more pet e-mail peeves. You can do so anonymously, and include your name or not. 


Tim Berners-Lee - Inventor of WWW

Eric Thomas - Inventor of Listserv

On paragraphs

Is text messaging infecting or liberating the English language? Judge for yourself, as we rewrite classic texts in txt. (BBC, 2003)

MEDLAB-L Guidelines 

The iPhone turns 10 (Just a kid and who knows what it will be when it grows up or if it becomes landfill like so much technology)

Thursday, May 25, 2017

The sound of silence (Musings on why it's key to criticize TM professionals / organizations)

Updated: 25 May 2017 
(Major revision from the blog initially posted.)

May's blog was stimulated by recent experiences I've had on a transfusion Twitter account. It deals with concerns about professionals speaking their minds versus being silent. As such it's a personal blog but I hope transfusion professionals everywhere will be able to discern the issues involved and how they may relate to their professional lives.

The blog's content is the type of thing folks don't usually discuss except perhaps with their trusted best friends (or in social media speak, their BFF).

Executive version: The blog is about decisions made on Twitter and on transfusion-related blogs like this one, which occasionally make me persona non grata with fellow tweeps and colleagues. The blog's focus is about the need for transfusion professionals to speak out and discuss the things that bug them, instead of remaining silent.

The blog's title comes from a Simon and Garfunkel song, circa 1965.

So readers can appreciate the context of where I'm coming from and what has shaped my views, some background.

In brief, I'm a lifelong medical laboratory technologist who began my career as a 'kid' at Canada's then national blood supplier (Canadian Red Cross) in Winnipeg in the pre-AIDS era that blood bankers often call the 'golden age of serology'. CRC is where I grew up professionally and the Canadian Red Cross Blood Transfusion Service (CRC-BTS) staff became my beloved blood banking family. The learning opportunities were abundant because Winnipeg's CRC-BTS was, and remains, the only combined blood supplier-transfusion service in Canada. Many of the staff became lifelong pals.

Later I lucked out by getting a teaching position as a lecturer, then professor, in the MLS program at the University of Alberta in Edmonton and a clinical instructor for the UAH blood bank, positions held for 22 years. I called these positions the best transfusion science teaching job in Canada, maybe the world, before choosing to give up a tenured university position to embark on new adventures.

With this background I've seen many changes, some I judge as good, some as bad, and been a keen observer of our profession for decades. Transfusion medicine remains a lifelong love affair.

It's obvious, but please be aware that what follows is my perspective and, as such, shows my biases.

As noted earlier, my TM career began with Canada's blood supplier CRC-BTS, now CBS. After being a med lab tech, lab supervisor, and clinical instructor at CRC-BTS, decades later I was privileged to obtain many consultant jobs with CBS - I loved them all - and briefly served as a lab manager of a CBS patient services lab. It's an organization Canadians can be proud of but, like any large organization, is not perfect.

Over the years I've criticized CBS on Twitter and in blogs for what I perceive as deception, hypocrisy, use of hackneyed business jargon, and more.

Some tweets I've made often occur on the spur of the moment and constitute errors in judgement. Some are because, as a bit of a contrarian, I see things differently than many or choose to reveal my true feelings on issues that others do not for whatever reason.

Reminds me of advice I'd give to Med Lab Science students:

Explaining how feedback is an indispensable tool to help both instructor and learner improve, and modelling appropriate responses such as, "Thanks for telling me that." When MLS students enter their clinical internship year, I'd explain that constructive criticism is their best friend. They can improve only if supervisory staff tell them when they are doing something wrong or doing something that needs to be improved.
That said, does CBS even want feedback from the likes of me, especially when it's often critical of their practices or constitutes a send-up? Perhaps not.

Sad but tweets about CBS could potentially cause folks I respect to unfollow me on Twitter. I know of at least one in the UK who has done so.

The blogs are a different matter. They're not spontaneous but a way to get something that bugs me off my chest. In a way they're therapeutic. I blog about an issue and feel better because I've said my piece and haven't remained silent. Often I wonder how the heck I've had the chutzpah to criticize a respected organization and its leaders.

So the question arises, is it preferable to keep silent or continue to challenge CBS to be even better? Or are blogs and tweets similar to pissing in the wind?

Fact: Most transfusion professionals choose to keep silent and not criticize organizations such as national blood suppliers for several reasons. First and foremost, the organization may be their employer. Or perhaps they interact with the blood supplier as a hospital client and want to maintain a cordial relationship. 

But the result is that the blood supplier often never knows where they need to improve because no one dares to tell them. Certainly rank-and-file employees usually don't. Reality is many employees outside an inner circle at head office, or not in management positions in blood centres, have long since given up offering feedback about policies because it's invariably ignored. At least it seems that way to 'trench workers'.

Directives and self-congratulatory missives emanate from CBS head office that staff in the far flung regions sometimes consider a joke, often so hypocritical that the missive is the exact opposite of reality. I could write a lot more on this from my experiences as a CBS lab manager but won't now.

Why should we offer honest feedback to TM colleagues and organizations? Because it's the only way they can improve. If we only promote what a great job they do, they will NEVER improve. And I want the organization I grew up in and love to improve.

As to errors in judgement, those mistakes are what I must learn from. If I've inadvertently offended colleagues, I apologize unreservedly. Being passionate about a subject can sometimes push me to say dumb things.

Does any of this resonate with your experiences? Are you deep into the 'sound of silence' as many, perhaps most, transfusion professionals are? Food for thought that I hope is palatable and doesn't cause you to choke.

This Simon and Garfunkel song fits this blog. TM professionals and organizations who might improve - if only colleagues would speak inconvenient truths - never can improve if the Sound of Silence reigns in the TM community.

Wednesday, April 26, 2017

I will remember you (Musings on TM colleagues past)

Updated: 30 April 2017 (Fixed typos)

April's blog focuses on a friend and colleague who recently died. How to write about Kathy Chambers after she so suddenly and unexpectedly died? Celebrate her life with a series of anecdotes on how she affected Canada's transfusion and quality community and beyond and especially those she closely worked with. 

Kathy's was the first blog in the CSTM's 'I will remember you' series (Further Reading). This blog allows me to be more personal and intimate.

For those who didn't know Kathy, I hope the blog has interest and value as a narrative on the complex interpersonal and mentoring relationships that exist in the transfusion workplace, indeed, any workplace. As you read it I encourage you to think of your own colleagues and how you interact.

The blog's title derives from one of Canadian Sarah McLachlan's songs.

Upon first meeting Kathy when she worked as a senior in the transfusion service of UAH, Edmonton I was struck by how she was so no-BS and down-to-earth, true to her Saskatchewan roots. She told it how it was, without the soft edges of political correctness. 

My gawd, I thought, this is the hard-nosed technologist I must collaborate with to develop the students' blood bank rotation experience? She was confident and a bit intimidating. If intimidating to me, an experienced transfusion professional, how would she appear to the 'kids' (as I call them to this day). 

Well, I needn't have worried. Kathy turned out to be the proverbial 'egg', hard on the outside and soft on the inside. She truly wanted the vulnerable neophytes (students) to have a good experience, to learn and grow during their clinical rotation. Kathy's confident exterior was intimidating, but she was warm and caring too, a trait that became increasingly clear the more I got to know her. 

Someone you could treasure as a lifelong friend no matter where life's divergent paths take you. 

At the CSTM 2000 conference in Quebec City, 10 years after she'd left Edmonton, Kathy introduced me to the then BC PBCO medical director and put me forth as the webmaster/content coordinator of its TraQ website. The offer came out-of-the-blue, totally unexpected, and was very kind given that we hadn't kept in close touch over the years. 

That conference generated many laughs. Kathy had such joie de vivre, always smiling and sharing an unspoken joke. 

TraQ was a dream job because I'd recently left a tenured position in MLS at the University of Alberta. After 22 years it was time for a new adventure and to give some of the 'kids' I'd taught a chance to transmogrify the job into the 21st C.

On subsequent trips to Vancouver for TraQ, and later on a CBS educational website project, Kathy always picked me up at the Vancouver airport (a chore in itself, given the traffic) and I stayed at her home and got to know her up close and personal.

One tidbit I recall is how we'd sit on her back deck each morning over coffee and she'd laughingly point out the neighbours who were suspected drug dealers.

To my surprise, I learned that Kathy gave me significant credit for something I took as normal. During her time in Edmonton she'd undertaken an ART (Advanced Registered Technologist), no longer offered by the now CSMLS. The ART was a way for Canadian medical technologists without BSc degrees to qualify for supervisory and managerial positions in clinical laboratories. 

Part of the ART requirement, besides a research project and oral examination, was a literature review. Kathy's lit review needed quite a bit of work and, as an experienced instructor, I gently suggested how she might improve it. Goodness knows who had taught her in the past because she inexplicably credited me for being a kind mentor and never forgot it. 

I suspect it formed the basis of her many acts of kindness to me over almost 40 years.

Fits with my experience that what we remember in life is mainly a series of small events (sometimes even seconds long) that strongly affect us positively or negatively and that we recall for the rest of our lives. 

I'm so glad that Kathy saw a small act in a positive light because her resulting kindness made my post-Med Lab Science career.

In 2000, Kathy and I were approached by Heather Hume, who had a vision to create a CBS educational website, which we did (2000-2003). Still think the site was a vein-to-vein masterpiece but impossible to maintain without considerable resources. Today, it's morphed to CBS's Professional Education site.

We had so much fun creating the original website. And I learned a lot from Kathy. Her breadth of experience was incredible. 

Towards the end of the project, Kathy and I had a parting of the ways, so to speak. The details are not important but, in retrospect, the fault was all mine. Indeed, Kathy went out of her way to rectify the situation and soothe my feelings but I was the stupid, hurt-feelings, hard-headed one. Keep this in mind for what comes next.

In 2007 I formed a consortium that was eventually hired by Alberta Health & Wellness to develop a Provincial Blood Contingency Plan to deal with severe blood shortages from pandemics and other causes (July 3 - Nov. 30, 2007). Folks I asked to form the Consortium included Penny Chan, Maureen Patterson, Dianne Powell, and Maureen [Webb] Ffoulkes-Jones, and yes, Kathy Chambers. 

As it turned out, Kathy Chambers became the 'de facto' lead under difficult circumstances and led the project to its successful conclusion. Quite an accomplishment and one that showed she had the 'right stuff', which I never doubted for a moment. 

Those of us involved refer to it as the 'project from hell' and Kathy was its saviour.  We can laugh about it now but not then.

When CSTM asked me to do a series of 'I will remember you' blogs, the first person I thought of was Kathy Chambers. She agreed without hesitating and, as was typical of her, quickly delivered the 'goodies' needed for the blog. 

Kathy was so talented and efficient throughout her entire career. How the heck could she have such focus? Amazing woman! A force of nature, a 'oner'. Like many in Canada and beyond, I'm fortunate to have known and learned from her. 

My best memories are of the many laughs we shared. Cannot see Kathy's face without a smile. I hope readers will recognize themselves and colleagues such as Kathy who have affected their lives for the better. 

Naturally, I've chosen Sarah McLachlan's song for this blog:
I will remember you, will you remember me? 
Don't let your life pass you by 
Weep not for the memories.


Sunday, March 26, 2017

Sweet dreams are made of this (Musings on conferences and why we attend them)

Stay tuned. Revisions sure to occur

March's blog was stimulated by Twitter, specifically a tweet by UK's Sylvia Benjamin (Further Reading) about the value and limitations of lectures (conference presentation) based on a podcast by physicians Rob Orman and Amal Mattu both with 1000s of followers (Further Reading). 

The blog's title comes from a song by Annie Lennox, one I've used before.

Executive version
This blog will highlight Orman and Mattu's excellent podcast and where I differ with them. Pretty nervy but it's no fun to always agree.

I'll be somewhat provocative and facetious about the real reasons many folks attend conferences and why conference presentations often suck. 

Also included will be strategies for how to make conference presentations better. I offer suggestions because, when Powerpoint (PPT) came out in 1990, I was mid-career in MLS and loved PPT (my handwriting is awful). Accordingly, I pretty much made all the mistakes that now jokingly constitute, 'death by PPT.'

Why continue reading the blog? Maybe for insights into giving presentations and listening to them? Or just to see how provocative I can be? Your choice.

The Orman-Mattu podcast has much useful information for presenters and educators but, after a lifetime of attending lectures at scientific and medical conferences and even giving some, I disagree with two of their premises. 

First, they discuss talks at conferences as if their main goal was to train and educate, then strike this aim down because presentation lectures often fail. Perhaps their premise is a logical fallacy that comes close to a straw man argument?

Second, the podsters claim that lectures are an inefficient way to transmit information and knowledge. That their only uses are to inspire or convince/convert.  About inspire, I confess that many conference keynote speakers are inspiring people who give inspiring talks. Yet even with them I seldom can recall what they said of lasting value. 

But lectures can do much more than inspire / convert. They serve other key functions, which include being efficient and effective ways to 
  • Transmit practical information not found in textbooks or published papers;
  • Emphasize and summarize what the crucial information is on a given topic;
  • Model how practitioners approach and think about problems;
  • Explain the evolving nature of technical and clinical practice and incorporate historical developments to show the big picture;
  • Model soft skills such as professional work attitudes, how practitioners approach feedback on performance, interpersonal and professional relationships and ethical dilemmas. 

In fairness, it may be that Orman-Mattu were giving an executive version of what lectures can do well. 

The presumptive purpose of delivering lectures at conferences is to train and educate, i.e., communicate something worth communicating. And often that fails on many levels. I'm reminded of this clip from Cool Hand Luke:

But is training and education really the main purpose of conferences? Allow me to be a bit facetious.


The accepted purposes of presentations (lectures) at medical conferences by researchers, physicians, nurses, medical technologists are to educate others and disseminate knowledge but the real purposes often include these. My Top Ten:
Perhaps, 'alternative facts'?

1. Present research findings, maybe new research or perhaps old research whose data's been massaged to get more published papers (main way academics are judged, despite lip service to teaching and service to the profession);

2. Justify the expense of attending;

3. Have something to put on academic annual reports;

4. Further one's career, essential to young researchers to obtain grant money to keep their positions;

5. Travel to new cities, even better if they're international and somewhat exotic;

6. Fluff egos: "Yes! I'm a 'thought leader' in my field. I can dine off this research talk at hospitality suites and Big Pharma din-dins for the entire conference."

7. Schmooze and spend quality time catching up with colleagues, often in the exhibitor area at vendors with the best free food and booze;  

8. Escape temporarily from family obligations, which can be especially onerous for females with a busy career, a home to run, and children to care for;

9. For pathologists and others who find social interaction and chit chat awkward, presentations give something to talk about, take the pressure off socializing;

10. For some folks, often married ones, conferences provide an annual opportunity to meet up with lovers (who may or may not be colleagues). Over time I've known quite a few people who regularly did this. They never discussed it with those who knew them, but the reality was an open secret among their colleagues. Just the way things are, never to be mentioned.

What can go wrong with presentations and why do they so often suck? 

1.Busy Slides
Think of the slides that many, if not most, physicians often use at conferences. I'm not picking on docs, it's just that they do most presenting at conferences. 

Invariably, they begin by apologizing for a busy first slide using a tiny font size that is unreadable at 10 feet. With slide after similar unintelligible slide, audience eyes gaze over and judgmental folks who know a smidgen about education / communication tend to think, rather uncharitably
  • 'What arrogance! Or is it laziness? Is he really that clued out? And, jaysus! Why didn't I sit at the back for an anonymous exit?'
2. Entire Sentences
Then there's the not-that-rare presenter whose slides consist of sentences presented in bullet format. As if that's not enough, he (yes, it's often a 'he') reads them word for word. Zzzzz....

Once saw presentations like this from a well known, prestigious researcher who held a high position in a blood system. Confess that I felt sorry for the guy because his level of shyness and fear of presenting must be extreme.

Still, it's torture to endure such talks. One of my favorite Dilberts is the guy who wants to be throttled rather than....(2010-02-28)

3. Ringing Bells
You expect  'ringing bells' aka verbal tics in nervous neophytes. Examples: um, you know, er, like, an almost silent 'okay' at the end of sentences, or ending sentences as if they were questions. Other verbal tics in those who should know better because they are experienced speakers include 'actually' and 'absolutely'. 

Trouble is, once you hear a presenter say a few, all you focus on is the repetitive ringing bells.

4. Pissing Contests
Another distractor may occur at the end of  presentations, where someone in the audience aggressively challenges the speaker over research methodology or conclusions, especially if the speaker did not mention them in the talk as limitations. Ex:
  • It's just an observational study, so weak and unreliable;
  • What new findings does your study show;
  • You didn't take into account these confounding variables;
  • Your small sample size lacks statistical power; 
  • The study has little external validity because....
Nothing the matter with peer feedback and constructive criticism except if challengers clearly have an axe to grind or want to get into a pissing contest to show how clever they are. Also, if they attack someone who is less well known than them, all pretense of collegiality ends and the feedback approaches abuse.

We like to think of transfusion medicine as one big happy family but I've seen such combative nonsense and it's not pretty. 

5. Attention Spans
I'll end this section with noting research about attention spans. An often repeated fact is the average attention span of students is 10-15 minutes, but there's no good evidence to support it. 

Research shows that college-aged students (the group most educational research is done on) listening to lectures have attention lapses during the initial minutes, again at 10-18 minutes, and then as frequently as every 3-4 minutes toward the end. 

I used to joke with my students after ~ 15 minutes that I knew they were fantasizing about sex. The mention of sex immediately drew their attention back to me. Indeed, nodding-off heads and glazed eyes would become alert and they'd invariably laugh. If lucky, I'd have them for the next 5 minutes.

Who knows how attention span research applies to adults. Indeed, older adults because we are an aging profession. And while not necessarily sex-obsessed, today's conference attendees cope with many distractions. They may think of the work piling up in their workplace, of the talk they'll give tomorrow, of aging parents or children and spouses at home, etc.

6. Attention-Getting Strategies
1. One way to maximize attention is to introduce your presentation up front and summarize what it will be about, why it's important, and what you hope listeners will get from it. This is akin to being 'above the fold' in newspaper parlance, i.e., stories that editors think will interest readers and sell papers.

2. Also, consider saying as an addendum to the intro, that if the presentation isn't what an audience member anticipated, it's okay to leave. Add something like,  'Seriously, I can take it and would hate to think of you feeling trapped. If it were me, I'd appreciate the same opportunity.' Believe me, you'll have the attention of everyone in the room.

3. Another effective way to get and keep people's attention is well known by reporters, sometimes called the 'Identifiable Victim Effect' or 'one person's story' effect.  The strategy is to focus on one or two individuals because an individual's story is always more compelling than statistics involving masses of anonymous people. 
  • An example from the 1970s Vietnam war is Phan Th Kim PhĂșc.
  • Perhaps the best recent example of this effect is with refugees drowning in the Mediterranean. The numbers who drowned are now into the 1000s. But nothing got the world's attention more than Aylan Kurdi.
Similarly successful authors tell the story of a few people or one family to illustrate larger learning points with more effect. Think of virtually any book you may read.

So how can conference presenters of scientific and medical studies / topics use the 'one person's story' effect to good advantage? Some examples:

1) Research: Audits of how well nurses follow hospital SOPs and policies when administering blood

Begin the talk with a summary of the story of two U.S. ICU nurses who were perhaps fired for not following their hospital's blood administration policies (Why were RNs fired, Further Reading)

2) Topic: Best practice for bedside identity checks prior to transfusion
Begin the talk with a summary of the story of the UK nurse who lost her license and was charged with manslaughter over an identity error that led to a patient's death. (Nurse spared jail over transfusion error, Further Reading)

3) Topic: Challenge of providing clinical training to students in an age of decreasing resources
or: Current issues in handling medical errors in a quality system

Begin the talk with a summary of a real case like TraQ's Case A-8: Severe Hemolytic Transfusion Reaction Involving a Student (Further Reading) or one you know of personally.

Such real-life stories have the added advantage of telling the audience why your research or topic is relevant.

My experience as a lifelong transfusion professional is that conferences invariably are top heavy with physicians and PhD researchers. Guess that's to be expected given that conference goals are to disseminate and advance research. Not that nurses and medical technologists do not engage in research, just much less often, given how hard it is to obtain funding these days and that research is not usually a core part of their job descriptions.

Also, for a long time it's become difficult for medical technologists to get funding to attend conferences, perhaps transfusion nurses too. 

Granted, today most transfusion conferences include a few front-line medical technologists who work in the trenches, often presenting at workshops. Similarly, there may be the odd talk (or workshop) by transfusion nurses.

The most important thing about any talk is its content and why it's worth disseminating to peers. On that point, conferences don't have nearly the reach of press releases and journal publications. If the research seems to a genuine breakthrough (or is made to sound like it is), local science media can be counted on to gladly gobble up the release almost verbatim because writers are always desperate for something to write about.

Podcasters Orman and Mattu spend time on explaining how to deliver a lecture (present at a conference), including offering only a few take-home messages and reinforcing them, plus using pictures / graphics more and text less. 

They also note the problem with handouts (often PPT slides with room for handwritten notes) that invariably get taken home, filed, and never read again. So true. 

A known problem with the ubiquitous PPT handouts is that audience members will read them and not listen to you. The same applies to bulleted slides, even if there's only a few bullets/slide. 

Of course, presenters love PPT because it serves as a handy crib sheet for the talk. To put up a slide with only a picture would require more effort and memorization. Granted, 'grand poohbahs' usually have given the same or a similar talk dozens of times, so are well rehearsed.

Face it. Most transfusion professionals are not 'rock star' presenters who can mesmerize an audience for 15 minutes or longer, especially when more than 50% of listeners have dined out and partied to the wee hours the night before courtesy of a diagnostic sales rep. 

Since most presenters will continue to use PPT software or similar for conference talks, it's at least prudent to know how to use it. Search 'death by Powerpoint' (~1.7 million Google hits, 26 Mar. 2017) and you'll see how many folks tell us how to avoid it.

But this Dilbert Powerpoint collection conveys the pitfalls more effectively. 

One person whose advice for presentations with PPT slides that I find useful is Garr Reynolds (Tips, Further Reading). An example (Source: Slide Share, Further Reading): 

Also Reynolds doesn't ignore the basics, such as what's the purpose of the talk and especially the 'So what?' message you should look for, including in scientific papers. 

For all transfusion professionals it's an honour to be asked to speak at conferences and increasingly a privilege to attend. Hence, Sweet dreams are made of this. Beyond the title, the song is a favorite of mine. 

An upcoming 'sweet dream' to keep in mind is the CSTM joint conference with the ISBT International Congress in Toronto, Canada , June 2 – June 6, 2018.

This blog's origin: Sylvia Benjamin tweet on a podcast  by Rob Orman with Amal Mattu 

Are medical conferences useful? (12 Aug. 2012)

Blog: The way we were (Musings on the benefits of attending conferences) -11 May 2013 

Garr Reynolds Presentation tips

Garr Reynolds Slide Share

UK: Nurse spared jail over transfusion error

USA: Why were RNs fired? 

TraQ: Case A-8: Severe Hemolytic Transfusion Reaction Involving a Student

Saturday, February 25, 2017

Take chance on me (Musings on transfusion professionals collaborating)

Stay tuned: Revisions will occur
February's blog was stimulated by the planned transition of an informal mailing list of Canada's Transfusion Safety Officers (TSOs) to the CSTM website. I've been the list manager and moderator since the list ('transfusion')  was created in 2000. The blog is shorter than usual, which is likely a good thing.

As part of the move, we did a survey of 'transfusion' subscribers, many of whom do not have the job title of TSO, but perform many of the same functions. Historically, mainly for financial reasons, most subscribers are Canadian but we've had a few foreign subscribers, including ones from Ireland, Switzerland, UK, and USA.

What is this blog about and why might you want to read it? Many other transfusion-related communication mechanisms (workshops,conferences) exist but today it's often electronic communication, such as websites with discussion forums. In transfusion medicine, PathLabTalk comes to mind, whose BloodBankTalk participants are mainly USA and UK medical laboratory technologists / medical lab scientists. 

Similarly, professional associations like AABB and BBTS offer discussion forums and my experience is that most posts are by technologists.

In contrast, Canada's TSO list includes medical laboratory technologists and transfusion nurses, including blood conservation nurses, and even a few physicians.

That's a huge advantage because transfusion service laboratories and nurses who administer blood transfusion really do need to learn more about each other and appreciate the role each plays.

The blog's title derives from a 1978 ditty by Sweden's ABBA.

For decades I've been privy to the views that med lab techs/scientists have on nurses, based on anecdotal experience in hospital transfusion services.

Common themes (misconceptions?) are that RNs do NOT
  • Understand quality control procedures and lack competence to do Point of Care Testing (POCT)
  • Truly dig the importance of patient identity and understand what can go wrong. Hence they're not that concerned if patient identities on specimen labels do not EXACTLY match those on blood transfusion requisitions, because, hey, they took that sample and know it's the patient.  Hence they think the lab is being anal-retentive on what they see as minor. 
It's possible that nurses have views of their colleagues in transfusion laboratories that are not always complimentary and may be based on sterotypes. I'd love to hear some. 

Transfusion nurses have come relatively late to transfusion organizations. But physicians have belonged for ages, indeed from the get-go. They tend to dominate proceedings as evidenced by talks at annual meetings.

Yet few physicians participate in transfusion lists and forums, or on Twitter. Why not? My guess is that some think of social media such as forums, lists, and Twitter as beneath them. Perhaps some can't be bothered to interact with the hoi polloi, meaning lab techs and nurses or is that too harsh? 

Or, unlike the laboratory and nursing trench workers of the transfusion community, most physicians are too busy (can't bother?) to talk to anyone but other physicians, and only at medical rounds, conferences, etc.? Please advise. 

Three Transfusion Pros Walked Into A Bar
To illustrate my point about stereotypes among transfusion professionals, I created a joke. Yes, it's satire with a smidgen of truth.
A female doctor, medical lab technologist, and a nurse walked into the bar. Oh, great said the bartender, we have a contest tonight and you are just the ones to play it. Out came 2 glasses and the bartender said, 'Guess which one is British and which is Canadian.'
The doctor considered herself a beer aficionado and passed on asking the age and history of the brews. Feeling more knowledgeable than her colleagues, and somewhat infallible, as she often did at work, she immediately stated, based on her gut feeling: Pale lager is Canadian, dark is British.

The nurse took and recorded the vital signs, including colour and temperature. She recalled Canadian beer was more likely to be pale yellow and served cooler and that Britain had dark ales. Her guess was the same as the doctor's: Pale lager is Canadian, dark is British.
The lab tech asked if a historical record existed of the samples in the glasses and which bottles they came from, and then demanded it. When told that would be cheating, the technologist replied, 'Sorry, we in the lab don't guess about identity.'
Correct identity thanks to the lab technologist (You knew this was coming):

If only med lab techs/scientists, nurses, and physicians could get to know each other better, transfusion medicine would be a better world. I've been lucky in Alberta, Canada, thanks to the Med Lab Sci program at University of Alberta, to have taught several students who went on to become hematopathologists. Their lab background is a huge plus. 

And I know from the TSO 'transfusion' list that technologists and nurses have benefited from learning the issues and challenges each has.

For interest: In 1994 when the Internet became available at my workplace, I created a mailing list 'MEDLAB-L' for medical laboratory professionals of all disciplines. I could have gone with a transfusion list but am so glad to have opted to be inclusive. Over the years lab professionals (med lab technologists / scientists, PhD level scientists, and physicians) in all clinical labs have benefited from learning about each others' issues.

The song I chose is a 1978 ditty by Sweden's iconic ABBA. It's meant to say to nurses and med lab techs and physicians to talk to each other on social media, break down stereotypes, trust each other, because we're all in this together.
As always, comments are most welcome.

Saturday, January 28, 2017

Four strong winds (Musings on trends identified by Malcolm Needs' 3rd CSTM blog)

Updated: 29 Jan. 2017
This month I'm going to feed off CSTM blogs on the career of the recently retired UK's Malcolm Needs (Further Reading). 

Typically, in the CSTM 'I will remember you' series of blogs, I offer my musings on what the featured author writes. But for January I've developed comments originally written for Malcolm's third CSTM blog (not yet published) into a stand-alone TM blog. So in a way this blog will foreshadow Malcolm's upcoming blog on regrets, concerns, and challenges, and serve as an advertising 'teaser' for it.

The blog's title comes from a 1963 song by the iconic Canadian duo, Ian and Sylvia. The blog is organized as a take-off on the song's title.

Strong Wind #1: AUTOMATION 
In his upcoming third blog, Malcolm mentions automation in the context of how it has changed the skill mix of staff employed in transfusion hospital laboratories. I've written about automation often including in 2010:
  • Goldfinger's filings, a customer's toolkit: Musings on business intelligence (Further Reading)
In the July 23, 2010 filing of its FORM 10-K Immucor (Form 10-K reports, which public companies file with the U.S. Securities and Exchange Commission, offer comprehensive business overviews of a registrant's business, such as history, competitors, risk factors, legal proceedings.) , one maker of blood bank automation (Immucor) writes:
'Our long-term growth drivers revolve around our automation strategy. We believe innovative instrumentation is the key to improving blood bank operations and patient safety, as well as increasing our market share around the world.'[Note they put improvements and patient safety up front, but increasing market share is their prime concern.]
'We believe our customers...benefit from automation. Automation can allow customers to reduce headcount as well as overtime in the blood bank, which can be a benefit given the current shortage of qualified blood bank technologists.' [Reduce headcount is a nice euphemism for get rid of staff and their costly benefits. Diagnostic companies also tout automation as freeing lab technologists/biomedical scientists to do more interesting tasks. And of course, if you can remove the human, you remove most of the error, or so it is said.]
  • 'We believe that instrument placements are the most effective way to gain market share ... Because our business operates on a “razor/razorblade” model....' [A razor/ blade model means give them the instruments relatively cheaply, because we can soak them with reagents costs, which continue forever.]
'In the new field of molecular immunohematology, we are currently developing the next generation automated instrument for the DNA typing of blood for the purpose of transfusion, which we believe will be the future of blood bank operations.' [And, by gawd, if a demand doesn't exist, we'll create one. See Strong Wind #4 below
Aside on automation: As a long-time transfusion science instructor (1974-99), graduates often told me they chose to work in hospital transfusion service labs because of the hands-on testing, correlating test results with patient diagnosis and history, and problem solving. They didn't choose clinical chemistry, in particular, because that clinical lab was heavily automated. Loading patient specimens on instruments and relying on software to flag abnormal results struck them as not nearly as engaging as transfusion science, or clinical microbiology, for that matter. 

Other grads obviously loved the highly automated clinical labs, and not just because job opportunities were more abundant. Of course, those who went to work for the blood supplier - on the 'dark side' as I affectionately call donor testing, where I enjoyed working in prehistoric days - inadvertently were sucked into the world of automated, mass testing of donor samples. 

Indeed, transfusion service labs whose test volumes warrant it, have moved into automated testing big time, as shown in the 'Goldfinger's filings' blog.

Strong Wind #2: LEAN
In his third blog, Malcolm also mentions LEAN. LEAN is a biggie in NA too, touted as an industry 'saviour', developed in Japan by the American Deming. LEAN expanded into health care ages ago. LEAN is promoted as allowing clinical laboratories and component production facilities to do more with less. 

For example, Canadian Blood Services (CSB) cooperates with Toyota and makes videos about  it. CBS higher level staff sport Master Black Belts in Lean Six Sigma. Jargon (~bafflegab) abounds as LEAN, Kaizen, and Six Sigma run together in a blur. 

Moreover, LEAN consultants make a great living by marketing it to health providers and training staff in-house. 

In 2008 I wrote a blog on automation and LEAN: 'Morning becomes Electra' (Further Reading). Refer to my views on whether automation and LEAN are progress, given that progress generally means improvement or growth, whether for individuals, organizations, societies, or humanity. 

Bottom line: Add automation and robotics to LEAN hospitals and soon we'll have gotten rid of all the non-value-added waste in the health system, as well as most of the health professionals. But is it progress?

In his upcoming blog 3 Malcolm mentions that, in an effort to streamline how laboratories work, and to standardise (Brit spelling - grin) the work, a 'one size fits all' campaign was instituted in all NHSBT reference laboratories. 

From talking to colleagues in the field, I sense that standardized operating procedures (SOPS) are now 'SOPs on steroids'. Some hospital transfusion service lab SOPs are now so complicated that even long-time transfusion specialists must consult them often as they perform routine procedures they've done 100s of times. Do 'busy' SOPs increase patient safety? To me it's likely staff lose focus on patients due to the extreme emphasis on paperwork. 

Whenever a national blood supplier in any country tries to standardize work across laboratories or regions, my initial reaction is Beware! In his blog Malcolm explains the ways in which standardization doesn't always fit. My guess is that frontline staff aren't consulted enough initially and the head office folks writing the SOPs don't have the experience to realize it's a no-go from the get-go. 

Later the organization may ask for feedback on the SOPs that have been rolled out but seldom acts on it. Staff may even stop offering feedback because they've learned it's useless. 

I saw staff giving up firsthand in my brief stint as 'assman' at CBS (1999/2000). Staff tolerated nonsensical inaction from head office, because their feedback was met with a brick wall of silence and un-returned e-mails. Perhaps more senior people on-site knew little, too, because they were never told. Frankly, I shook my head in bewilderment at how dedicated, talented staff had come to accept the unacceptable. But, being naive, I went up the chain at head office until I found someone with real authority, who, when told what was occurring, fixed it immediately. 

About nation-wide SOPs:
  • Sometimes it seems as if they've been written by folks who have never performed the procedure, at least not currently;
  • Or maybe the writers know one lab's methods and don't understand that it won't fit others, a version of the clichĂ©, 'a little knowledge is a dangerous thing';
  • Or perhaps standardization is a significant someone's current hobby horse;
  • Or, and here's the crux of the matter, standardization will save money in writing and revising. Never mind that they won't work operationally for every laboratory.
What's going on with SOPs in hospital transfusion service labs is a mystery. But I suspect it relates to government regulation and inspections by Health Canada (HC). 

HC regulators presumably gather input from all the stakeholders before new standards / regulations are instituted. But how much medical lab technologists / scientists play a role is debatable. 

My sense is that HC inspectors of transfusion labs have little, if any, first-hand knowledge of working transfusion medicine. Their concern focuses on documentation that processes have been validated and paperwork exists, regardless if it adds to patient safety, or even if they don't truly understand what it means. 

Also in his third blog, Malcolm welcomes blood group genotyping as long overdue in immunohematology labs. 

As with any new technology, many constraints to widespread adoption exist, including staff expertise and cost. In the USA an added roadblock has been convincing government to pay for special DNA blood grouping when some of it is hard to justify with evidence. Naturally, patients with the money can get it. 

Again, see my 2010 blog, 'Snip, snip, the party's over?' for an overview of the issues (Further Reading). I see genotyping as a great innovation, but decry the increasing move to expand its uses beyond what can be justified clinically as a return on investment (ROI) in the technology. 

Moreover, I understand why, given that some folks have built their careers on it, and also dig the seductive lure of 'personalized medicine' (typical, over-the-top Rah!Rah! snake oil).  

For interest, see the UK's 'Red Book' (incredible resource) on 'Clinical applications of blood group molecular typing'.

In his upcoming third blog, Malcolm identifies concerns and challenges and shows hope for the future of TM labs. The issues he identifies are significant forces. Automation, LEAN, standardization, and molecular blood grouping are 'four strong winds' currently shaping transfusion medicine laboratories worldwide. At their heart, I see these 'winds' as deriving from 
  • Vested commercial interests;
  • Cost constraints and the need to do more with less;
  • Government regulation gone amok.
Given Malcolm's four topics, I decided the 1963 song by Canadian icons Ian and Sylvia was too good to resist. Of interest, in 2005 this song was voted the top Canadian song of all time, quite an honour given that Canadians have written many great songs. 

The song is a reflection on a failed romance, but the phrase, 'if the good times are all gone' resonates with me. Of course, even the earth's seas and mountains change over time, nothing is forever. Also, as an Alberta resident for ~40 years, I can attest there is plenty to do here all year round. 

Not sure, however, just who all these TM changes/trends benefit. As always, I hope the blog is 'food for thought' for readers. Watch for Malcolm's multiple blogs at CSTM. His second will be published this weekend (Jan. 28-29) and third in Feb. 2017.
  • Four strong winds (Ian and Sylvia 1986 reunion concert)
    • At end see Murray McLauchlan, Judy Collins, Gordon Lightfoot, Emmylou Harris (left to right) join them on stage.
Four strong winds that blow lonely, seven seas that run high,
All those things that don't change, come what may.
If the good times are all gone, and I'm bound for moving on,
I'll look for you if I'm ever back this way.

Comments are most welcome.