Saturday, July 11, 2009

"Transfusion lite" - Back in the USSR?

This blog is a provacative sendup of a new journal affiliated with the AABB.

In the July issue of Transfusion AABB announced a new journal, The Journal of Blood Services Management, in an editorial by Paul M. Ness and Philip D. Schiff: "The Journal of Blood Services Management, a new administrative focus for TRANSFUSION":

The JBSM will include a broad spectrum of organization and management issues facing blood service managers. Topics will include financial management, supply chain management, LEAN/6 Sigma, regulatory matters, manufacturing management, donor recruitment, public relations and communications, information technology management, hospital and customer relations, governance matters, international issues, services within hospital-based blood services, tissue program management, risk management, competition, leadership, and general medical and technical service management.

I have not read the first issue because it is not available on the web and I have not yet received my paper copy of Transfusion. It's always late for some reason, maybe due to residing in Canada?
The new journal (JBSM - sorry, I could not resist the emphasis) is a collaboration between AABB and Group Services for America’s Blood Centers (GSABC).
The GSABC mission statement:

  • "To create a stakeholder-driven group purchasing enterprise that more effectively serves the members of America's Blood Centers"
From JBSM overview (on the GSABC website)
  • The Journal of Blood Services Management will be the premier journal for thoughtful leaders in blood center and transfusion service management.
Articles will generally fall into two broad categories:
  1. Those grounded in theory and/or papers using scientific research methods....
  2. Those focusing on innovative blood service management approaches that are based on well reasoned-extensions of existing research, experiential knowledge, or exemplary cases (e.g., thought pieces, case studies, top executive interviews).
The journal wants articles that are "engaging, lively, challenging, and stimulating." I particularly liked this tidbit:

We recognize that many potential authors may be intimidated at the thought of writing for a peer reviewed Journal. We wish to reassure these authors that the editorial staff is willing to assist in any way possible to help you write a paper for submission. For those who have never written a paper for peer review, you may wish to think of it as nothing more than writing a “term paper”.

"Nothing more than writing a term paper" is an interesting choice of words, given that the journal is targetted to "thoughtful leaders."
I am confident that most AABB members, including me, will thoroughly enjoy JBSM:
  • I like thought pieces and approaches that use experiential knowledge, which are more or less the equivalent of blogs like this one. No need to use scientific research methods and worry about solid evidence.
  • Papers will be more practically oriented, hence more relevant to those who work in the TM trenches beyond the research milieu of academia. Many Transfusion papers remain unread for various reasons, including content that is perceived, rightly or wrongly, as irrelevant to practice and content that is beyond the reader's knowledge base.
Despite being keen about a new transfusion journal with promising content, I cannot help but wonder if the appearance of JBSM is yet another baby step on the long journey to making financial concerns and cost efficiencies paramount in transfusion medicine.
Transfusion medicine as a business is also featured in the June 2009 issue of AABB News, which includes a report on an NFB Leadership Forum held in April in Florida:
  • NBF leadership forum focuses on innovating for the future

According to the report, attendees at this private meeting discussed issues that would be at home on the programs and in the board rooms of any business or industry. Speakers included industry leaders from
  • Ortho-Clinical Diagnostics
  • GE Healthcare
  • Haemonetics
  • Fenwal
  • Bay City Capital (venture capitalists)
  • ITxM
  • Florida Blood Services
  • Puget Sound Blood Center
  • AABB
  • ARC
Advice included recommendations to
  • Examine the potential for partnerships, mergers, and outsourcing
  • Implement lean strategies to decrease waste
  • Focus on productivity indicators
  • Diversify income
  • Centralize compatibility testing
  • Compete against other health sectors for investment capital
  • Develop technologies that reduce labor and reagent costs
Recommendations more clearly TM-related with direct clinical implications were to develop blood utilization programs and transfusion guidelines.
Oh, yes, "and we must remember the donors and patients because that is who we are trying to serve." (Jim AuBuchon, President and CEO of PSBC)
As has been noted in earlier blogs, as the economy has worsened, papers that promote cost analysis as a primary driver of TM policies such as donor testing have become more common. Patient safety always enters such cost-focused papers and presentations but almost always as an after-thought or a robotic mantra unrelated to the actual take-home messages.
QUARTERLY PRAVDA? (Pravda definition)
JBSM's scope fits rather nicely with the ideas expressed at the NBF leadership forum. It could serve as a propaganda arm of the GSABC, AABB, and NFB. Thought pieces and interviews on financial management, LEAN, and competition could easily promote ideas currently favoured by 'captains of industry'.

Ah, but what about peer review, you say. Well, peer review of traditional scientific papers has been criticized for years:

Particulary troubling is the long trail of evidence that demonstrates that peer reviewers are often biased toward papers that affirm their own convictions.
Where does this leave peer review of non-research based papers such as thought pieces and interviews of TM bigwigs?
As a political analogy (try to jettison your own biases on this topic), think of former US VP Dick Cheney holding forth on his favorite theories and world view:
  • Who among George W. Bush's cabinet, aides and other 'true believers' is going to be the bearer of bad news that the VP's views do not stand the test of evidence?
  • There is Colin Powell, but we know what happened to him.
JBSM promises to be an interesting addition to the transfusion literature. I could have joined the crowd and praised its appearance instead of giving it this tongue-in-cheek critique and calling it Transfusion lite and raising the possibilty of its use as a propaganda tool. But that would not have been thought-provoking or challenging, virtues praised in the new journal's overview.
  • Paul singing "Back in the USSR" (Red Square, 2003), only possible after the fall of the USSR
  • CD has wonderful scenes of joyous Russians reacting to the once fobidden music

Comments are most welcome BUT, due to excessive spam,  please e-mail me personally or use the address in the newsletter notice. Participate in peer review....

Addendum to last month's blog: "Plus ca change, plus c'est la meme chose (Where are the Hearts of Gold?)" (Musings on why publishers charge for celebrating the dead)