If you could read my mind (Musings on blogging to share TM experiences)

Updated: 23 June 2016

June's blog is a follow-up to an article I wrote for the April issue of the BBTS magazine, BloodLines. In the BBTS piece I speculated on why so few health professionals, working or retired, blog. I'll expand on some of these ideas in the hopes that more transfusion professionals will be encouraged to give it a go and blog for CSTM or BBTS or any professional association in any country.

Now before you rapidly exit ('Blog? Not me!'), please take a chance and at least skim the blog. It's you I'm hoping to reach by planting a seed that maybe, just maybe, you could make a real difference by sharing your experiences with colleagues.

You don't need to be a 'big wheel' to blog. We tiny cogs in the wheel also have much to share. Perhaps we haven't published or presented at conferences. But we've all had unique experiences in our transfusion lives and, in years to come, no one will know if we don't tell our stories.

The blog's title comes from a 1970 song by Canada's Gordon Lightfoot, one of the most covered songs in pop music history. 

OBSTACLES

So why don't more transfusion professionals blog? There are many reasons, but here are my top three. 

1. No time
Most obviously, and likely the biggest obstacle to blogging, is lack of time. Like many continuing education opportunities these days, folks would need to blog after-hours on their own time. 

With internet and cell phones, many employees may already resent being connected 24-7. When work-life balance is out-of-whack, leisure time with friends and family, as well as time for yourself, becomes even more precious. 

And if you feel devalued by your employer, you may lose the enthusiastic puppy persona you had at the start of your career. Instead of a career, you may see your professional work as just a 9-5 job to earn money, not to gain fulfillment.

2. No incentive
Another obstacle to blogging is folks tend to get no credit for blogging. Indeed, blogs may even be dissed by the 'old guard' as not evidence-based, just opinion. Well, yes! Blogs offer OPINIONS on events, issues, and challenges of the day.

But blogs can offer evidence and present logical arguments. In some ways blogs are akin to editorials. Opinions by experienced health professionals can summarize issues, pro and con, and offer food for thought. 

3. Fear of ridicule

Every time you 

• Open your mouth
• Give a presentation
• Put pen to paper
• Write an e-mail message 
• Participate in social media of any kind

you may say something silly or indefensible and risk being thought a fool. Been there, done that. Indeed, you may even open yourself up to abuse by pompous academics or online trolls.

But to me the opposite is even worse:

• To avoid criticism, say nothing, do nothing, be nothing. (Attributed to...) 

ADVANTAGES

So, why blog, given its risks? Here's where I'll need to self-edit for brevity because I'm definitely a true believer in the merits of blogging.

Given that blogging is an enterprise done on your own time, why do it? 

Why I blog
I blog for 6 key reasons. Blogging...

1. Is a priceless opportunity to comment on issues of the day and try to shape opinion. One example from "Musings on Transfusion Medicine' - my likely futile attempt to shape opinion on paid plasma:

• Simply the best (Musings on paid plasma and TM colleagues I've know)

2. Allows us to celebrate colleagues who have made a difference and to record transfusion medicine history through the eyes of those who lived it, the good, bad, and ugly. See, for example, the Canadian Society for Transfusion Medicine (CSTM) blog series, 'I will remember you' (scroll down to see the 6 blogs to date).

About history, Australia and new Zealand offer a great example of how to preserve our past:

• ANZSBT 50th Anniversary (1964-2014)
• Reflections of Past Presidents 
• Fun presentation of 1964 news

3. Makes you a better thinker and writer. It's simply a case of practice improves performance. As noted in my first BBTS blog, 'Born to be Wild', key points to any writing, even e-mail, include

• Don't bury the lead - reveal blog's aim up front;
• Make it easy to read by using bullets and short paragraphs;
• Be as brief as possible;
• Include a 'so what' statement.

I confess that my blogs are too long. Please don't take them as a model of suitable length. A blog can be short and deal with a single issue or experience. 

4. Creates a record of important experiences and allows others to learn from them. 

EXAMPLE:

I could write a blog about a student I once taught who, during her clinical rotation, missed adding patient plasma to an antibody screen test, causing it to be falsely negative, with the patient receiving incompatible blood by electronic crossmatch. The elderly patient suffered a severe hemolytic transfusion reaction and subsequently died.  

This true episode makes an interesting story of what happened, including the involvement of the hospital's lawyers, the reaction of the supervising technologist and transfusion service medical director. Much to be learned from a single experience, a story worth writing that would be lost forever if not recorded. 

5. Gets your name out there and furthers your career. Of course, blogging requires taking a risk, the risk of opening your mouth and being thought a fool. No big deal. I have a T-shirt from LSOFT:

• "He Who Dares, Wins" (motto of the British Special Air Service)

6. Is great fun. Fact is, I enjoy poking the powers-that-be and sending up the absurdities in our professional lives. Someone has to do it.

SUMMARY
Expressing opinions on current issues and examining the past are valuable ways to spend one's time. So seldom today do we get the opportunity to reflect. And blogging invariably serves as informal continuing education because bloggers need to check they're not spouting total B.S.

Some claim that in today's milieu, folks no longer have the time, no longer care to spend free time on their careers. Please, let's prove this judgement wrong.

My take on blogging: It's a blast! I maintain three blogs, two professional and one personal where I pretty much rant about whatever bugs me at the time. The personal blog is therapy that keeps me sane. 

The professional blogs are my way to try to influence opinion, to motivate colleagues to think differently and challenge orthodoxies. You can too! We're here for such a short time. Why not try to make a difference?

Plus we need to create a historical record of our stories or they will be lost forever. See, for example,

• Life as a blood eater

Making colleagues smile also serves a valuable purpose. What struck you as silly recently? Why not blog about it? If you want to try blogging for CSTM, I'd be glad to help by offering my 2¢ worth (make that 'nickel's worth', as cent coins/pennies don't exist in Canada any more).

To inquire about blogging, please e-mail

• CSTM webmaster
• BBTS

Finally, I encourage bloggers to write their passions and will end with this quote by Canada's Margaret Laurence (click to enlarge):

FOR FUN

Lightfoot's 'If You Could Read my Mind' seems right for this blog. Fact is, no one can read our minds. If we don't spill the beans and blog about our experiences, no one will ever know. 

• If You Could Read my Mind (Gordon Lightfoot, live TV performance)

If you could read my mind, love,

What a tale my thoughts could tell.

Just like an old time movie,

'Bout a ghost from a wishing well.

In a castle dark or a fortress strong,

With chains upon my feet.

You know that ghost is me.

And I will never be set free

As long as I'm a ghost that you can't see. 

                                        

If I could read your mind, love,

What a tale your thoughts could tell.

Just like a paperback novel,

The kind the drugstores sell...

As always, comments are most welcome.

The In Crowd (Musings on the relevance of transfusion journals)

Stay tuned because updates will occur

May's blog was stimulated a long time ago but returned to me recently when I was cleaning house and tossed out (recycled) several thick issues of the AABB journal Transfusion, which were piled on my computer desk, largely unread after scanning content indices.

The blog's title derives from a 1965 jazz instrumental by the Ramsey Lewis Trio.

Musings focus on the articles I read in Transfusion's May 2016 issue and what this says about the journal's relevance to someone with a medical laboratory technology/science background (me). For context, traditional measures of a journal's relative importance and Transfusion's top 10 cited articles are also discussed. 

The questions I hope to answer: 

1. What value is the AABB journal to practicing transfusion professionals (as opposed to its value to authors/researchers)?
2. Why am I (and presumably everyone) getting a paper version of the journal and not being given an option for an e-journal only?
3. What would my AABB membership fee be if all the costs associated with a paper version of Transfusion were eliminated?
4. What factors should affect a journal's overall relevance and importance?

The blog is written from a medical laboratory technology perspective, as that's my background, but the issues also relate to nursing and physicians. Regardless of where you live, please ask similar questions of your professional association's journal. For example, 

• How many papers do you typically read in your transfusion-related professional journal and where - at work on breaks, at home? 
• Do you scan titles only or a combination titles, authors and abstracts? 
• Which criteria determine whether you will read a given article?
• In deciding what to read, how important is an article's direct relevance to your daily work?
• How many articles, if any, do you read just for curiosity or fun?

Sometimes I wonder of journals even matter anymore but of course they do. And I miss the days when transfusion services regularly held journal clubs during lunch hours, often based on journal articles or conferences, in which all staff participated.

To promote continuity of the blog's ideas, consider reading the blog in its entirety and then return to access linked resources. Bet you can't.

1. AABB JOURNAL 'TRANSFUSION' - BRAGGING RIGHTS

So to begin, here's how most journals measure their worth. On its homepage, Transfusion gives its ISI journal citation ranking under the medical specialty, hematology, as well as its Impact Factor. Both are intended to show the relative importance of individual journals. 

In 2014 Transfusion's ISI Journal Citation Reports^© Ranking was 23/68 and its Impact Factor was 3.225. 

So what do ISI Journal Citation Reports© (JCR) Ranking and Impact Factor (IF) mean?

• JCR Ranking claims to objectively critically evaluate the world's leading journals using statistics. Uh-oh! That's a red flag if there ever was one. Just kidding because, as with any statistical data, users need to use their noggins to assess validity. 
• With a JCR rank of 23/68, my guess is that Transfusion ranks no. 23 of 68 journals and is in the top third of most hematology journal citations (two-thirds of similar journals have fewer overall citations, whatever complicated statistics are used).

• Impact Factor is the average number of annual citations recent journal articles have and obviously the higher, the better. As such, it's a proxy for the relative importance of a journal in its field. 
• With an IF of 3.225, recent Transfusion articles were cited an average of just over 3 times in a year.

But similar to surrogate tests such as elevated ALT and anti-HBc used to screen blood donors for non-A, non-B hepatitis before HCV was identified, issues exist for how well Impact Factors measure relative importance.

For interest, The Impact Factor was devised by Eugene Garfield, who explains its history in a 2006 JAMA article.

As an aside,  I love Garfield, because in my early pre-Internet years in Medical Laboratory Science, MLS subscribed to Current Contents, which I always enjoyed and looked forward to reading. If my memory is correct, each issue began with a fascinating Garfield comments/editorial. [See Further Reading]

2. TRANSFUSION'S TOP 10 CITED ARTICLES
Since 1975 I've been an AABB member and once read 90%+ of Transfusion's articles, but mostly for interest, not because they directly related to my work. 

Most reading was done because I'm curious and love transfusion medicine. After becoming an educator, motivation included the potential to discover 'juicy' tidbits that would interest or amuse students, and Transfusion's articles often did. 

In today's hectic and understaffed work environment, I wonder which of Transfusion's top 10 articles would be read during leisure time, on breaks or after hours, by 

• Clin lab technologists/scientists in a blood supplier or transfusion service laboratory? 
• Transfusion and blood conservation RNs?
• Hematologists/hematopathologists?

I suspect that not many in these three professions would read 3, 7 and 9 below, which is good because only 30% un-read is excellent. As an experiment, please assess which of the following you would read. I've linked the PubMed abstract for each article. 

Please think about which criteria helped decide whether you would read an article or not.

Transfusion's Top Ten Cited Articles: [Author's work location/country]

1. Activity-based costs of blood transfusions in surgical patients at four hospitals. (Shander A, et al) 2010;50:753-65. [USA]

2. Transfusion of older stored blood and risk of death: A meta-analysis. (Wang D, et al) 2012;52:1184-95. [USA]

3. Pathogen inactivation and removal methods for plasma-derived clotting factor concentrates. (Klamroth R, et al) 2014; 54:1406-17. [Germany]

4. Is fresh-frozen plasma clinically effective? An update of a systematic review of randomized controlled trials. (Yang L, et al) 2012;52:1673-86. [UK]

5. Fibrinogen as a therapeutic target for bleeding: A review of critical levels and replacement therapy. (Levy JH, et al) 2014; 54:1389-1405. [USA]

6. Duration of red blood cell storage and survival of transfused patients. (Edgren G, et al) 2010;50:1185-95. [Sweden]

7. Storage lesion: Role of red blood cell breakdown (Kim-Shapiro DB et al) 2011;51:844-51. [USA]

8. The use of fresh frozen plasma in England: High levels of inappropriate use in adults and children. (Stanworth S et al) 2011;51:62-70. [UK]

9. Adoptive transfer and selective reconstitution of streptamer-selected cytomegalovirus-specific CD8+ T cells leads to virus clearance in patients after allogeneic peripheral blood stem cell transplantation. (Schmitt M et al) 2011;51:591-9. [Germany]

10. Transfusion-associated circulatory overload after plasma transfusion. (Narick C, et al) 2012;52:160-5. [USA]

So, what's your health profession and  how many of these top cited papers would you have read? Be honest. As both a lab technologist in the trenches and an educator, I'd have read all but #9.  

3. TRANSFUSION'S MAY 2016 ISSUE
Below are three papers I read in the May issue of Transfusion (Volume 56, Issue 5,pp. 1001–1249) that directly relate to my prior career as a med lab tech/scientist and educator. Yes, only three and I read them out of interest. These days,although retired from real work, my time is even more precious. 

The journal sections each paper is under are included. I've summarized each with a 'So What?' conclusion.

1. TRANSFUSION MEDICINE ILLUSTRATED (pp.1006–7)
Delayed hemolytic transfusion reaction captured by a cell phone camera.Margaret E. Gatti-Mays, S. Gerald Sandler [USA]

So what? The delayed hemolytic reaction was due to anti-Jk^a and shows a photo of the peripheral blood smear with multiple microspherocytes. Authors encourage physicians to use cell phone cameras to photograph peripheral blood smears and use them in clinical presentations. 

2. IMMUNOHEMATOLOGY (pp. 1182–4)
Anti-Mur as the most likely cause of mild hemolytic disease of the newborn. Sara Bakhtary, Anastasia Gikas, Bertil Glader, Jennifer Andrews [USA] 

So what? Full term infant had jaundice presumed to be due to anti-Mur, an antibody more commonly found in Asian patients in the USA, and one important to recognize since the Mur+ phenotype has a higher prevalence in this population.

3. LETTER TO EDITOR (pp.1247–8)
Sustained and significant increase in reporting of transfusion reactions with the implementation of an electronic reporting system. Rosanne St Bernard, Matthew Yan, Shuoyan Ning, Alioska Escorcia, Jacob M. Pendergrast, Christine Cserti-Gazdewich [Canada]

So what? In 2009 the authors transitioned from a paper-based to an electronic reporting system (ERS) for suspected transfusion reactions. The user-friendly process did not result in “junk inflations”. Instead reporter suspicions generally concurred with specialist conclusions. Accordingly, they endorse using an ERS for transfusion reaction reporting to improve hemovigilance.

ANSWERING THE QUESTIONS
Here are my answers  - conditioned by my professional experience and biases - to the questions posed about Transfusion. Your answers may differ and likely will.

Q1. What value is the AABB journal to practicing transfusion professionals (as opposed to its value to authors/researchers)?

A: Transfusion has value as a good read for anyone who's curious on current 'hot' clinical issues and to educators who must keep up-to-date with the latest and greatest, including esoteric research, which may or may not ultimately translate into something useful to practitioners.

The journal's relevance to the day-to-day working lives of medical laboratory technologists/scientists in laboratories is minimal. Most papers relate to clinical practice (MDs, RNs) or research (PhDs).

Q2. Why am I (and presumably everyone) getting a paper version of the journal and not being given an option for an e-journal only?

A: Transfusion is a glossy journal that costs many trees to produce, plus mailing costs, which are not insignificant. I don't need or want a paper copy.  

It's published monthly, plus has supplements of Annual Meeting abstracts and others such as conference proceedings. That's a lot of paper.

For May's issue I read only 7 of 248 pages, ~2.8%, which related directly to my work. And some issues have even fewer articles relevant to my needs and interests.

Q3. What would my AABB membership fee be if all the costs associated with a paper version of Transfusion were eliminated?

A: My 2016 AABB membership cost $124 USD, which at the time I paid was $170.27 CDN. Sure, membership is a good deal, less than 50 cents/day.

But how much of this does AABB pay per member to Transfusion's publisher, Wiley? Darned if I or any member knows.

Academic publishers such as Wiley and its subsidiaries, e.g., Wiley-Blackwell,  surely make most money from advertisers and libraries. It's interesting that they've been under pressure recently for being an oligarchy that gouges cash-strapped university and college libraries. [See Further Reading]

Q4. What factors should affect a journal's overall relevance and importance?

A. To me, Transfusion's relevance should relate not only to its citation ranking or impact factor. Rather, a key factor is how many articles in each issue busy transfusion professionals will actually read because they relate to their day-to-day jobs.   

Yes, it's easy to dismiss my views because immunohematology (beloved to med lab techs/scientists) is a dying art and increasingly irrelevant. But how many papers in the 2016 May issue would time-strapped nurses and physicians read in their spare time? You decide.

Transfusion comes with AABB membership. Shouldn't its content reflect the needs of ALL members, at least according to their membership percentage?

SUMMARY
Just a few of the many issues I'd love AABB to address:

1. AABB, please allow members to opt out of receiving a paper copy of Transfusion and please decrease membership fees accordingly. 

2. AABB seems an association mainly for physicians. Is it? Why does its journal offer only continuing MEDICAL education credits for reading select articles and successfully completing a test on the content? I think I know why...

Cannot help but wonder what percentage of AABB's membership constitutes physicians vs PhD researchers vs medical lab scientists vs nurses vs administrators. Transparency please. We'd love to know.

3. Never mind med lab technologists/scientists, how about more Transfusion articles relevant to nurses? They increasingly play a key role in our profession. 

Of course, I know from experience that asking AABB or any large organization such questions is pretty much useless and akin to pissing in the wind. Would love to be proven wrong.

FOR FUN
I decided to use 'The In Crowd' in the blog's title for these reasons:

1. It's a laid-back, simple tune that's easy to listen to. Indeed, over the years I've listened to it for many hours because I bought the Ramsey Lewis album of the same name many moons ago. 
2. Although it's an instrumental version, the lyrics fit with the blog's theme of promoting a journal based on its relative ranking and impact. Hey dude, don't ya wanna publish in the 'In Crowd' journal Transfusion?

I'm in with the in crowd.
I go where the in crowd goes.
I'm in with the in crowd.
And I know what the in crowd knows.

Tidbit: I've got this album somewhere if I could only recall where I stashed the few 33¹⁄3 rpm vinyl records I've kept.  

• The In Crowd (The Ramsey Lewis Trio vinyl album, recorded live at the Bohemian Caverns in Washington, D.C. in 1965)

As always, comments are most welcome. 

FURTHER READING

Academic publishers reap huge profits as libraries go broke (CBC, June 15, 2015) 

Larivière V, Haustein S, Mongeon P. The oligopoly of academic publishers in the digital era. PLoS ONE 10(6): e0127502. E-pub: June 10, 2015 (Free full text)

Just for fun
Confession: I've included these just so I have a record and can read on some long winter nights.

The writing of Eugene Garfield, including

Essays of an Information Scientist:1962 - 1973 

Essays of an Information Scientist:1974 - 1976 

Essays of an Information Scientist:1977 - 1978 

Ex:  Humor in Scientific Journals and Journals of Humor

Don't worry, be happy (Musings on the loves & hates of a lifetime in transfusion medicine)

In honour of Valentine's Day, February's blog is about some of the things I've loved about transfusion medicine over the years. See how many jive with yours. And don't worry, the blog won't be too sickeningly sweet. That's not me.

The blog's title comes from a 1988 ditty by Bobby McFerrin. 

LOVES

1. Organized chaos in the transfusion service laboratory

Phones ring - timers go off - specimens and requisitions arrive - perform historical checks in computer - RBC needed STAT for gunshot wound - aortic aneurysm has blown - start massive transfusion protocol - thaw frozen plasma - night tech calls in sick - patient has positive antibody screen - identify red cell antibody - exclude possible antibodies - open donor segments to antigen type - pos control doesn't work - repeat the test - short of O Rh neg RBC - call blood supplier for more - patient specimen arrives whose ID doesn't check with what's on requisition - call nurse on ward, take flak, stay calm and explain - etc. 

Whew! Time to leave already? How time flies when you're having fun.  Brief next shift and go home feeling satisfied and proud of what you do.

2. Managers who...

• Don't play favorites and develop transparent processes for how perks, if any, are allotted
• Regularly thank staff for a job well done
• Tell you when you screw up (in private) and suggest how to improve, so that you can
• Don't stay cocooned in their office but instead walk around, observe, and talk to all staff 
• Go to bat for staff with higher ups and other departments and never, ever diss staff in front of others
• Encourage staff to learn and, whenever possible, offer accessible, inexpensive opportunities for continuing education and professional development

• And especially practice Steven Covey's advice for building trust by being true to those who are absent.

Being true to those who are absent means never discussing one staff member in a disrespectful vein with another, i.e., not gossiping and backbiting others. 

A manager with a track record of talking about others behind their backs quickly loses trust.

3. Colleagues who...

• Keep positive inside and outside the lab, as opposed to holding bitch sessions at coffee about the latest 'rotten' thing that management or 'the system' did
• Put in close to 100% effort or more, most of the time, realizing that we all have bad days
• Share knowledge and experience generously as mentors and consciously model how experts think about problems
• Practice reflective thinking about work-related issues (technical, clinical, educational, etc.) and their own lifelong journey to develop expertise
• Have empathy for new staff and students, realizing that if one person is elevated, we all are. 
• Motivate colleagues by holding up a mirror and showing them a positive image. 

As George Bernard Shaw said of friends, 'The only service a friend can really render is to keep up your courage by holding up to you a mirror in which you can see a noble image of yourself. '

4. Health professionals (physicians, nurses, technologists, pharmacists, etc.) who...

• Respect laboratory and all health professionals for their unique skills and expertise
• Treat colleagues in different health disciplines as equals, regardless of relative status in the health care pecking order
• Show respect and kindness to all staff, especially non-health professionals who do the scut work in hospitals and blood centres with little pay and status

5. Students and trainees who...

• Accept constructive criticism, even when it hurts, realizing it's the only way to improve
• Recognize that educators and trainers are people too and cut them slack from time to time
• Ask questions and challenge the status quo 
• Listen carefully

HATES
Obviously, the opposite of the qualities above but also

• Manufacturers and suppliers who distort truth about their products and services, even a little, in order to gain sales and maximize profits
• Health professionals in senior positions who become cozy with industry and end up becoming their de facto poodles

FOR FUN
For all colleagues who practice my 'loves':

• You're simply the best (Tina Turner's 1989 mega-hit)

And for Valentine's Day, many songs fit but I favour this one by Canada's Celine Dion

• My Heart Will Go On

As for 'hates', I try to practice the advice in Bobby McFerrin's song

• Don't Worry, Be Happy 

In every life we have some trouble - When you worry you make it double - Don't worry, be happy...... 

I'm sure I'll add to the list in the following days. If you have any loves or hates to suggest or argue with, please comment below. 

Smile on your brother: Musings on labour woes in the blood system

The idea for this month's blog came from the latest labour relations difficulties facing North America's blood suppliers. The title derives from the lyrics of a 1960s song recorded by many, Get Together.

USA - American Red Cross [ARC]

• Staff cuts at ARC harm blood supply, coalition says
• Connecticut: Red Cross workers: Phlebotomist firings due to contract tiff (includes comments from fired worker)
• Southern California: Nurses may strike over wages, benefits, practices
• Background (labor's perspective): Labor relations at the ARC and its impact on employee and donor safety (23 page report by Philip Dine)

Canada

• Canadian Blood Services (CBS): Nurses vow to fight CBS pilot to phase out RNs from donor screening
• CBS: "Moving forward to pilot multi-skilled workforce"
• Hema-Quebec [H-Q]: H-Q deplores union's attitude and invites the public to give blood

This blog uses the above labour conflicts to offer musings on the role of trust among TM health professionals. Because the underlying issue in any management / employee negotiation relates to trust, I will not discuss the specifics of the news reports. Besides, without in-depth knowledge of what is actually happening, analysis would be folly.
Many good friends are either staunchly pro- or anti-union health professionals. I know from experience that discussing union issues, like religion and politics, is sure to lead to passionate disagreements fueled by anecdotes and emotion, not objective, evidence-based logic, and may result in hard feelings. I'm hoping not to wander into that morass as the blog's narrative unfolds.
UNIONS
As background, to my knowledge, Canada's blood system, both blood suppliers and hospital-based transfusion services, are mostly unionized. Unionized workers usually include laboratory technologists, lab assistants, and nurses, and a diverse group of other staff, e.g., clerical, IT, lab scientists, maintenance, etc.
Some employees, e.g., TS laboratory managers and blood centre management positions, may be "out of scope" (not included in union contracts).
Practical implications of being out-of-scope include the

• ability to negotiate salaries and benefits directly with employers (and to keep them private from co-workers);
• subtle promotion of a them-versus-us mentality;
• ability of employers to fire you without the hassle of a union grievance.

As well, for non-union health professionals at senior levels, including dismissal terms in personal contracts, and threats of legal action for wrongful dismissal, may result in generous, golden handshakes for staff such as TS and blood centre medical directors.
Many of the news items referenced in this blog involve contract negotiations. From my experience observing Canada's blood system, frequently workers do not trust employers / management to do the right thing for employees, patients, and the public at large. The worker view is often that management has a hidden agenda, typically to save money, even at the expense of safety.
Conversely, it's not that rare for employers / management to regard unions negatively, and by extension to view their members as overpaid and more or less lazy, with unions leading to unwarranted, costly job perks and promotion of the most senior rather than the most competent staff. Management seldom voices such opinions publicly and would deny them if asked, but these viewpoints exist nonetheless.
Indeed, these perspectives reflect public opinion, with proponents on both side of the union issue.
The unproductive, adversarial mentality in labour negotiations seems relatively common everywhere despite major progress in labour relations worldwide during the 20^th C.
The sad fact is, that with contract negotiations, a lack of mutual trust is common. When discussions reach an impasse, each side often sees the other as self-serving and sometimes in even more negative terms.
Tidbit: In 2007, the percentage of employees that were members of a trade union (Source: OECD - Union density 1960 - 2007) included:

• Australia: 10% (2006)
• Canada: 29.4%
• Norway: 53.7%
• Sweden: 70.8%
• UK: 28%
• USA: 11.6%

These statistics likely do not include the employees such as physicians and university professors who are not members of a union, per se, but do belong to professional associations that act as unions by negotiating contracts and benefits.
A ROSE BY ANY OTHER NAME
When is a union not a union? When it calls itself a professional association. When working at the University of Alberta I was in the Association of Academic Staff, which negotiated salaries and benefits for professors. The Association's activities approximate that of a trade union.
In Canada, health care is a provincial jurisdiction and provincial medical associations negotiate physician fees that are binding for insured services.

• See Paying for Physician Services in Canada (1996)

Despite their loftier broader goals and objectives, Canadian provincial medical associations perform some of the same functions as unions. Yet unions may be disdained by some professionals partly because of their origin as trade unions, with "trades" somehow being more lowly than professions.
For interest, Norwegian and Swedish physicians have no problem in identifying their medical associations as unions. Many of their physicians are state employees, as are physicians in many other European countries.

• Swedish Medical Association
• Norwegian Medical Association

To my knowledge, Canada's transfusion medicine physicians (hematologists, hematopathologists, pathologists) who work for transfusion services and blood suppliers are usually salaried employees, although they often have multiple appointments that earn additional salary. In essence, they too belong to professional associations that function partly as trade unions.
TRUST
People who work as part of any health care team must trust each other's competence, trust that each will to do the best job possible, maintain a high level of quality care, and put the patient first. There are checks and balances in the TM system, e.g., audits of blood transfusion requests, error management programs, etc., but the system would not function without trust in a colleague's motivation and competence. The first instinct of health professionals is to trust each other to maintain high practice standards, unless shown otherwise. For example:

• When talking to a nurse on the ward who reports a possible transfusion reaction or to a physician in the ER who requests unmatched RBC, do lab technologists routinely think, "That lazy bum is so self-serving"?
• When discussing follow-up treatment of patients suffering from transfusion complications with nurses, or holding a staff meeting with laboratory staff to plan implementation of an new LIS, do TS medical directors routinely think, "These nurses / techs deserve less pay and fewer benefits"?
• When management staff from national blood suppliers consult with blood centre medical directors across the country, does "head office" routinely think, "These MDs don't have patient safety at heart. Their attitude is deplorable."?

Do management staff who are not members of a health profession (whether representing health regions, hospitals, blood suppliers, or governments) often think such thoughts about members of the TM team?
I think not. The many technologists, nurses, and physicians that I have known over a lifetime in Canada's blood system are dedicated to patient safety and trust each other to provide the highest quality care possible.
How is it that trust seems to evaporate with labour negotiations?
CASE STUDY
In the mid-90s in Alberta, health care restructuring caused major job losses in the laboratory sector. One result was the creation of Calgary Laboratory Services* (CLS), a private lab that assumed 100% of clinical lab services in Calgary, one of the province's two major cities.
* CLS is now a wholly owned subsidiary of Alberta Health Services (organization responsible for providing publicly funded hospital and other health care in Alberta)
The case study below describes how a union (HSAA) and private-sector lab (CLS) cooperated under extremely traumatic circumstances. It paints a rosy picture of what's possible. I have no idea how closely it conforms to reality but there may be some lessons here.

• Beyond Collision: High Integrity Labour Relations. Calgary Laboratory Services -- HSAA Case Study1 (2004, by Darcy Shenfield and Allen Ponak)

All this lack of trust and conflict reminds me of a song from the 1960s:

• Get together (performed by the Youngbloods)

As the song's lyrics go,

C'mon people now, Smile on your brother Ev'rybody get together, Try and love one another right now

Comments are most welcome BUT, due to excessive spam, please e-mail me personally or use the address in the newsletter notice. Let me know if you think I'm off the mark.