Saturday, January 19, 2008

To consolidate or not to consolidate? Who shall inherit the wind?

This blog entry's title is a take-off on He that troubles his own house shall inherit the wind...(Proverbs 11:29), i.e., if you create problems for your own community, even if inadvertently, it will come back to you in some way. The play Inherit the Wind, whose title comes from the biblical proverb, is about limiting an individual’s freedom to think. These themes run throughout this blog.

By serendipity I came across the blog, Save our Blood Service, subtitled "Don't mess with the NBS". The blog's purpose appears to be to try to prevent centralization of the UK National Blood Service and to inform workers about related events.

NOTE: The discussion that follows represents my personal views alone.

The UK plan to go from 14 centers to only 3 centres is currently being reviewed (possibly due to widespread opposition by staff?) with a decision expected shortly. From what I can tell, the planned reorganization has been in the works since at least the Fall of 2006.
There are no doubt multiple rationales for the plan, but a major one must be saving money. And since staff accounts for a major percentage of costs, presumably staff layoffs will occur. Accordingly, there have been protests over blood centre cuts.
Canada experienced a similar process in which CBS consolidated to 3 testing centres for the entire country (except for Quebec, where Héma-Québec is the blood supplier), as well as other reorganizations such as using one consolidated call centre.

From my perspective, despite efforts by CBS, the Canadian initiative was preceded by years of uncertainty in which staff first wondered if their centre would be one of the lucky ones to remain as a test site, followed by more anxiety about what would happen to them once they knew for certain that their centre was toast, test-wise. Telling staff that they were being kept apprised of decisions, providing communication mechanisms to alleviate concerns, and promises of support to help staff obtain new employment did not appear to lessen the angst significantly.

Over the years, it has seemed to me that when restructuring occurs that threatens significant layoffs - such as the massive changes that happened in Alberta in the early to mid-1990s -
some management decisions have been temporarily held back from front line staff ostensibly to facilitate their ability to focus more positively on the work at hand. Of course, it is a policy never admitted to publicly.

The powers-that-be may act paternalistically and appear to believe that staff cannot handle bad news that threatens their livelihood. Moreover, a relatively common scenario, particularly for letting middle management and more senior staff go (valued, long-term employees), involves telling them at the very end of a business day that their services are no longer needed, simultaneously removing their computer access, and escorting them to the door. These practices do not engender loyalty in staff who remain.

As to CBS restructuring and what it accomplished, in March 2002 CBS had 4756 staff employed mainly in 14 regional centres. In 2001/02, blood operations expenditures were $351 million, a 14.7% increase over the previous year.Combined administration/overhead for the national level and regional centres was $85.4 million, representing 24% of blood operations expenditures.
  • Source: Performance Review of Canadian Blood Services. Final Report (Oct. 15, 2002)
I do not know how many staff are now in blood operations and realize that new initiatives may have increased staffing in some areas. But presumably there are valid comparisons that can be linked to consolidated testing and restructuring.


One of the goals of creating CBS in 1998 after the so-called tainted blood tragedy documented by the Krever Report was to achieve transparency. To my knowledge, although CBS annual reports have outlined in general terms some of the efficiencies and benefits resulting from restructuring and consolidated testing, CBS has never published a comprehensive report documenting what was achieved financially as savings to tax payers who fund the service, and documenting benefits to hospital clients (transfusion services) and improved patient safety. If such a report exists, I'm sure my esteemed colleagues and friends in CBS will show me the light. (big grin)

If the UK NBS plan goes ahead, staff would find it useful to know ahead of time what the proposed advantages are, not just in terms of motherhood claims (it will save money; it will result in improved services to hospitals, etc.) but in terms of financial savings and other hard criteria against which success can eventually be measured. My experience has been that staff appreciate being told the straight goods. As well, should layoffs result, treating staff respectfully as valued employees, and as adults who deserve to know the reality in order to plan their futures, should be a given, indeed, a priority.

Personally, I will find it fascinating to see if the UK plan goes ahead and, if yes, in what form. If a country the size of Canada, the 2nd largest in the world, can have but 3 test centres for English Canada, it would seem that the UK can. Some of the key questions are
  • What are the savings and how will they be realized? (staff, equipment, overhead, etc.)
  • How many staff will be laid off or otherwise dealt with?
  • Are there significant benefits besides saving money?
Equally fascinating will be examining why the plan did not go ahead, if it does not. Protests did not stop the massive restructuring and downsizing that happened in Alberta in the '90s. But it's reassuring to see people try to influence the decision makers and inform colleagues, such as whoever created Save our Blood Service has done.

The blog's title is somewhat ironic because people who argue for restructuring typically cite change as being necessary for survival and see change as the way to save the system. The question is, what kind of change and does it really achieve its stated goals. If you do not get it right, you generate continuous cycles of centralization and decentralization that are satirized in A surrealistic mega-analysis of redisorganization theories.

Regardless, blogs have a bottom-up approach, a form of people power that I admit to liking. Kudos to the person behind
Save our Blood Service!

Feedback is welcome - please just click on Comments below.

NOTE:The following feedback was provided by Ian Mumford, Chief Operating Officer, Canadian Blood Services, who gave permission to post it.

Pat-- Your blog was recently brought to my attention. Although you offer opinions on a wide range of issues I want to specifically respond to your January 19, 2008 comments regarding the consolidation of donor testing within Canadian Blood Services.

It appears you are uncertain as to the reasons for the consolidation. The objectives were very clear, right from the beginning. The primary objective was to increase the safety of the blood supply. This objective was the overriding factor for all decisions.
Improving safety was done by:
  • Introducing new technology with improved sensitivity, specificity and reproducibility
  • Creating an environment that expedites the assessment of new tests, methodologies and instruments
  • Decreasing the amount of time required to implement new tests that address emerging threats
  • Standardizing processes across CBS
  • Enhancing process control through automation
  • Moving to an integrated, fully GMP compliant, quality-driven system
The secondary objective was to increase the cost effectiveness of testing.
Improving cost effectiveness was done by:
  • Streamlining and improving the processes in place
  • Maximizing the testing throughput for expensive, highly automated testing equipment
  • Increasing cost management by standardizing consumables and supplies and leveraging a national procurement process
As you note a number of staff were impacted. A comprehensive Career Bridging program was developed for those staff. The program included educational and relocation allowances in addition to severance packages (as provided for in collective agreements). Staff members impacted by the consolidation of testing were given priority for available positions if they wished to relocate to a future consolidated testing site. A number of staff took this opportunity and many have had careers with progressive responsibility as a result. In addition, some staff members at a future consolidated testing site who were impacted by the MAK Progesa implementation were able to be reassigned to testing and other staff members found other job opportunities within CBS.

So what has happened?

The primary objective for increased safety of the blood supply has been met. The three Donor Testing laboratories are now highly automated with testing platforms that are the state-of the art for donor screening, e.g. the Abbott PRISM for serological transmissible disease testing and the Roche s201 system for West Nile Virus testing and Galileo for antibody screening. Most processes have been standardized with clear points of process control, many of which are automated. Standardization of processes has permitted staff transfer to an alternate site for short periods to manage implementation of major projects. A laboratory information system (LIS) has been implemented to increase process control for the automated transfer of test results from test equipment to LIS and after appropriate review, the upload of these results to MAK Progesa for the appropriate management of donors and blood components. There has been a decrease in testing critical non-conformances. We have had increased agility to introduce new tests such as West Nile Virus in response to an emerging threat. WNV was implemented in less than six months, an achievement that could not have been contemplated before consolidation. We now have the ability to manage single unit WNV testing during the infectious season on a real time basis.

The secondary objective for increased cost effectiveness in donor testing has also been met. The project expected to decrease the cost of baseline testing by 6% in the first year. This objective was exceeded by 100%, the first year on going costs were reduced by 12%. There has been continuous improvement in cost management year over year through efficiencies in utilization of assay kits and reagents and standardization of consumables and supplies.

Over the last decade, donor testing has continually increased in complexity and the level of technology available. These changes, which have improved the safety of donor testing, have made the concept of multiple, small laboratories unsustainable practically and economically.

Change is always challenging, especially for those directly involved and I can appreciate that all of the communications and support we provide may not lessen the angst. It's interesting that although some staff want to know about even the possibility of change months and months in advance, others tell me they only want to be informed when final decisions are made and a way forward is set.

Overall the consolidation of donor testing was successful and impacted staff were treated with the upmost of respect.

Ian Mumford
Chief Operating Officer
Canadian Blood Services

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