Tuesday, December 11, 2012

Here Comes the Sun (Musings on putting fun back into transfusion medicine)

Updated: 28 Mar. 2021 (Fixed links)
This month, some light fair for December, Here Comes the Sun (Musings on putting fun back into transfusion medicine). The title comes from one of my favorite George Harrison songs.

The blog was stimulated by the Royal College of Pathologists of Australasia social media campaign to encourage viewers to imagine a "World Without Pathologists." Gee, I often dreamed of that when working in the transfusion service lab and later, when teaching. Just kidding, sort of.

 Some videos that I hope will tickle your funny bone. 
First, take-offs on 'Call Me Maybe' by Canadian Carly Rae Jepsen, which is up for a 2013 Grammy as Song of the Year.
Non-health versions:  Many health professionals use XtraNormal to produce fun videos that highlight the in-jokes of inter-professional relationships. Examples:
Medical schools have a tradition of producing humorous videos. One that I particularly enjoy is by University of Alberta med students:
Very funny, give it a chance. Part 2 has its moments too.

Hope you get a few chuckles from these inside jokes. If you know of similar videos, please let me know. 

The blog's title comes from one of my favorite Beatle ditties. I live in Edmonton, the northernmost city in North America but we are one of Canada's sunniest cities, getting more than 17 hrs. of sun per day at summer solstice. 
And just because this clever remix with Rita Hayworth dancing in 10 of her movies is fabulous:
If this doesn't make you feel good, you're not alive. Also enjoy original with John Travolta strutting his stuff:
Comments are most welcome and can be anonymous or under your name.

Merry Christmas, Happy Chanukkah, Happy Holidays to all.

Wednesday, October 31, 2012

You don't own me (Musings on TM professionals as industry's poodles)

Updated 1 Nov. 2012

This month's blog is about how much of the TM information we consume is meant to inform, how much is crafted to persuade, and how much info purveyors assume we’re owned by them, i.e., their poodles. The title is from a 1964 Lesley Gore song. 

The blog was stimulated by 3 items:
1. Supposed news from new-medical.net in its 'Insights from industry' section:
2. The article motivated me to visit OCD's 'On Demand' website and register to see its offerings. 

3. Then I was reminded of a recent research paper by OCD staff published in AABB's Transfusion:
Increasingly, I suspect that industry owns the transfusion medicine community. In a way, it's natural given that TM was healthcare but now is business and has been for awhile. Businesses depend on each other to survive. You scratch my back and I’ll scratch yours.

Today's AABB is more and more cosy with commercial interests, which is also natural given the reliance of the former on the latter for advertising revenues and conference support. Plus, as noted in earlier blogs, some AABB luminaries have close ties with industry. It's one big happy family.

The blog’s components  - industry promoting automation via 3 mechanisms - are akin to a full court press in basketball in which industry pressures TM staff from every angle to buy into their false assertions about automation.

The blog's theme is how much industry thinks it owns us and attempts to baffle our brains with BS. 

A common thread in industry’s automation initiative is to create false arguments. For example, manual methods have more processes than automation (true), therefore automated instruments have fewer chances for human errors to occur (true). 

BUT… here’s the logical fallacy (the BS, if you will): Where do most serious TM errors occur? Are they related to manual testing? 

Read and assess for yourself.

First note where this interview was published: news-medical.net

As with many so-called health sites, news-medical's business model is not immediately apparent without reading the fine print. And let's face it, that's the first thing we do when visiting a website, right?

Part of the 3239 word, 27 point,Terms and Conditions:
News-Medical hereby discloses that a commission or listing fee may be payable by Experts to News-Medical for any fees received by them as a result of an introduction of a client through the Website.  
Unsurprisingly, the site's underlying purpose is to sell stuff.

Besides industry news, news-medical, based in Australia, cheaply repackages health information from several sources, including a heavy reliance on Wikipedia under the Creative Commons Attribution-ShareAlike License.

Below is my summary of a few highlights of OCD’s Celia Tombalakian's interview with news-medical.net in question and answer format, with my comments, aka musings, in italics. Readers are directed to the full interview for exactly what she said. 

The report is selective and my approach is facetious in places. But is it off the mark? You be the judge.

QUESTION: How is the blood banking industry currently being transformed?

CT: Current focus is to improve transfusion safety and efficiency through technology solutions.  
Ah, safety and efficiency, with safety mentioned first. Who can argue?
CT: Over past 20 yrs, the number of highly skilled technologists and scientists entering the global TM workforce has shrunk. 
CT: Therefore, automation is becoming a standard part of blood bank laboratories because it eliminates many of the labor-intensive, time-consuming manual testing that requires specialized skills and significant experience to master.  
Really? Her response implies that automation arose because of staff shortages, which misleads in a chicken and egg sort of way.  
Why has the highly skilled technical and scientific TM workforce shrunk? Many reasons around the globe, inc. poor compensation for education involved (mainly USA), decreased health care funding, leading to regionalization and centralized testing, all facilitated by automation.  Automated instruments continue to be marketed on their ability to decrease absolute numbers of highly skilled staff.
CT: Ultimately, automation can increase a lab’s capacity and help it operate more efficiently, even with a smaller staff. 
A case can be made for how instruments are more reliable than humans, at least for some things. But notice there's no more mention of safety, only efficiency.
QUESTION. Tell us about the new Bloodbanker App and its benefits over traditional blood banking tools.

CT: ORTHO's Pocket Blood Banker app is an educational reference tool that combines genotyping and antibody indexing. Users can quickly determine genotypes based on results with Rh antisera via the Genotype Calculator and learn more about antibodies with the Antibody Index.
CT: Prior to the app, blood bankers used reference tools such as cardboard slide rules. 
You gotta be kidding. Cardboard slide rules? Maybe that's what Ortho supplied customers back in the Jurassic age, but for decades I and many others taught MLS students how to determine Rh genotypes using their ... wait for it ... inbuilt computers, aka brains.

Reminds me of this exquisite Danish humour on computers: Medieval helpdesk
CT: Drawing from a deep understanding of the importance of and need for innovation in blood banking, OCD identified the need for more advanced tools and developed this new technology. The app reinforces our commitment to providing innovative solutions to our customers. 
OMG, classic marketing and branding. We're wise, we're innovative, we're dedicated to helping clients. Please bring us cute babies to kiss. 
QUESTION: Could you introduce Ortho ON DEMAND and how it fits with OCDs overall focus?

CT: ON DEMAND is an innovative virtual engagement platform that enables blood bankers to learn from and connect with experts on topics central to achieving science-driven safety and efficiency in the blood bank. 
Attempt to reinforce Ortho's brand as innovative, Also love 'virtual engagement platform' and 'science driven.' Buzzwords convey modernity and objectivity, respectively. And note re-introduction of the safety and efficiency double whammy.
CT: With OCD’s strong TM history, we understand the importance of supporting industry through education and awareness. 
We're the pros, we understand. Trust us.
CT: Because many of today’s blood bankers work longer hours with fewer financial resources, many laboratories have had to cut costs that previously supported career growth opportunities. Through our new platforms, we hope to help prepare blood bankers to address growing demands for TM expertise. 
Excuse me? Labs have had to cut CE and CPD funding because staff work longer hours with less money? Does not compute. Pure bafflegab.
As for helping a growing demand for expertise, is there a growing demand for expertise? If so, it's to address what automation created in the first place, namely a diminished demand for technical and scientific expertise with fewer positions for TM specialists.
Frankly, automation and apps both contribute to and help alleviate a 'dumbing down' of the profession. I acknowledge that 'dumbing down' is a harsh catch phrase for staffing with less qualified personnel, not that such staff are dumb. I use the term to emphasize that apps do not contribute to developing expertise, but rather exist to alleviate lack of it.
QUESTION. What impact do you think these initiatives will have on blood bankers?

CT: Many of today’s blood bankers struggle to do more with less, working longer hours with fewer financial resources. Concurrently, instrumentation is more complex and the number of transfusions is increasing globally. 
Meaningless bafflegab. Yes, cost constraints force blood bankers to do more with less.  
But instrumentation is more complex? More complex than what? Earlier instruments? Manual testing? Do sales reps' spiels include these words?  "Hey, our instrumentation is more complex. You need better trained dudes to operate it."   
Also, in an age of blood conservation and a kazillion studies on real and unproven potential transfusion dangers, what evidence exists that transfusion numbers have increased? Does not compute.
CT: With reduced resources, many labs cut travel costs to learning events that could better prepare staff to address growing demands for TM expertise. Ortho ON DEMAND addresses this challenge by offering TM professionals free access to education according to their own schedules.
Offering free online education has merit. But it's not exactly true that today's over-worked TM professionals are clamouring to access education on their own schedules. Employers allot no time during work hours. Staff who are under-paid and feel under-appreciated are increasingly less motivated to take time away from families to further their careers.
QUESTION: How do you think the future of blood banks will develop?

CT: While technology has made many routine BB tasks faster and easier, the demand for blood continues to rise and the pace of processing blood continues to accelerate.  
Demand for RBC transfusions (type that automated instruments process in transfusion service labs) is increasing? Where's the evidence? Surely all the efforts on blood management, blood conservation, and improved utilization are having an impact on RBC usage.
Pace of processing blood continues to accelerate? What does this mean? I could speculate but she doesn't explain.  
CT: Hemovigilance and ensuring efficiency is of utmost importance to blood banks in maintaining a safe and accessible blood supply while keeping pace with accelerating demand for blood processing. 
Sounds good but what has hemovigilance to do with OCD's automation and apps? And again the unexplained 'accelerated demand for blood processing.'
CT: The future of blood banks lies in technological solutions that will allow blood bankers to increase safety and efficiency in order to provide the best possible outcomes for patients. 
Motherhood statement. But where is the evidence that automated ABO and Rh group testing and automated antibody screening have improved outcomes for transfused patients? Or that apps that generate Rh genotypes and describe antibodies have made a difference? 
Surely, getting patient identification correct when drawing blood samples and correlating patient identity to crossmatched donor blood when administering blood remain THE hallmarks of safe transfusion practice, the 'right patient, right blood product, at right time' mantra. 
QUESTION: What are OCDs plans for the future? Would you like to comment further?

OCD is the global leader in Transfusion Medicine, stemming from a 70-year history of protecting the safety of the worlds blood supply. We intend to continue our leadership of the market into the future, both with our products and through our service and support of the blood banking community. 
Forgive me, but I'm jaundiced. Although I've known, liked, and respected many Ortho reps, having just read Blood Medicine (aka Blood Feud) about Ortho Biotech and Amgen's marketing of EPO products, protecting patient safety as applied to J & J or any Big Pharma company rings hollow.
Author Q & A

Simply put, Ortho ON DEMAND offers varied worthwhile educational talks by respected TM professionals, but promotes automation. To illustrate, the first 4 talks in its Presentation section are about automation. 

I'm reminded that Ortho and its competitors such as Immucor operate on a razor-blade business model: cheap razors (instruments), with the real money made on expensive blades (reagents).

This paper by OCD employees further shows how industry treats TM professionals like poodles, hoping to baffle brains with BS. 
Interestingly, one of the authors, TS Casina, an OCD marketing manager, also penned these 3 articles:

Casina TS. Technologies to improve the future of blood banking. Med Lab Obs 2011 Oct;43(10):32. Excerpt:
  • 'As the labor force shrinks, the rapidly evolving field of laboratory medicine is struggling to keep pace with the growing demand for blood and its components. Automation is becoming a standard part of blood bank laboratories because it can help eliminate the labor-intensive, time-consuming manual testing processes that require specialized skills and significant experience to master.'
Casina TS. What's new in transfusion services. Advance for Med Lab Professionals. Posted online 19 Sept. 2012. Excerpt:
  • Transfusion of incompatible blood has the greatest potential for severe adverse events and health complications, including death. Fortunately, due to advances in transfusion medicine (TM) practices -improved blood testing, donor screening and the advent of automated systems - the blood transfused to patients is safer today than it's ever been.
Casina TS. References for "transfusion medicine reactions. Advance for Administrators of the Laboratory 2012 Oct;21(10):20. This paper is a reworked version of the one above. Excerpt: 
  • A study conducted by Ortho Clinical Diagnostics provides quantitative evidence of how automation could transform pretransfusion testing processes by dramatically reducing error potentials and thereby improve the safety of blood transfusion.  Evaluating the common testing methods above and leveraging failure modes and effects analysis (FMEA) to compare error potentials, the group concluded that automation significantly reduces defect opportunities in pretransfusion testing and could dramatically improve blood transfusion safety.
Can you see how marketing managers use a full court press and recycled material (with the help of willing publishers desperate for articles) to get their message out to industry's poodles, namely us?
Abstract Highlights (Transfusion paper)
BACKGROUND: Human error associated with manual pretransfusion testing is a cause of transfusion-related mortality and morbidity and most human errors can be eliminated by automated systems. 
STUDY DESIGN AND METHODS: Study’s goal was to compare error potentials of commonly used manual (e.g., tiles and tubes) vs automated (e.g., ID-GelStation and AutoVue Innova) group and screen (G and S) methods. G and S processes in 7 TS labs (4 with manual and 3 with automated methods) were analyzed to evaluate error potentials of each method.
Tiles?  Really? Well, they could be large welled plates. But who uses these in routine manual pretransfusion testing?  
RESULTS: Manual methods contained more process steps ranging from 22 to 39; automated methods contained 6 to 8 steps.  
Roughly 4-5 times more steps for manual methods. Authors then use ‘risk priority numbers (RPN)  - trust me, you don’t want to go there -  to show manual method RPNs ranged from 5304 to 10,976 vs 129 and 436 for automated methods, conveniently making manual tests away more than 4-5 times as risky as automation.
What the hey! Let's go there. A team (needed to reduce subjectivity) of OCD researchers and staff at 7 TS labs determined how many defects were likely at each process step (defect opportunities) and decided where failures could occur, the likelihood that the failure would be identified, how frequently the failures might occur, and what the effects of those failures (severity) were. The result was a 10 point scale. An example: 
Process Step 16 (tile or plate required tapping and rocking before reading reactions) had 18 defect opportunities. 18 represents 6 wells in the tile or plate in which it was possible to undertap reactants (6 defect opps), forget to tap the plate (6 defect opps), or overtap and splash reactants among wells (6 defect opps) for a total defect opportunity of 18 at that step (6 + 6 + 6 + = 18). The severity was rated 7 out of 10.
Wow! Talk about creative number crunching to get the results you want. The mind boggles....
CONCLUSION: This study provided quantitative evidence on how automation could transform pretransfusion testing processes by dramatically reducing error potentials and thus would improve the safety of blood transfusion.
Oh sure. Is I or is I not your poodle?
This study’s logical fallacy posits (love that word!) that most, or even many, serious transfusion errors result from manual testing of ABO and Rh groups and manual antibody screening. It's true that manual testing has potential to create more errors than automated testing.

The best evidence of where TM errors occur comes from the UK’s annual SHOT Reports. For example, consider 
I’ll not bore you with too many specifics  - you can read for yourself - but believe me, it’s NOT all about lab staff making technical errors when manually testing. 

'Adverse reactions caused by errors' lists these causes of cumulative cases reviewed 1996-2011 (n=9925):
  • Anti-D errors 
  • Inappropriate & unnecessary
  • Handling & storage errors
  • Incorrect blood component transfused (n>3000)
To quote SHOT: Key lesson from 2011 is an emphasis again on the importance of the essential steps of the transfusion process:
  • Taking the blood sample from the correct patient 
  • Correct laboratory procedures
  • Issuing of the correct component
  • Identification of the right patient at the bedside at the time of transfusion
  • It is clear from the SHOT 2011 data that identification of the correct patient remains a key issue and that this must become a core clinical skill.
So, what's it all about? Yes, automation can increase efficiency and increase safety by reducing human error. But is automation the TM saviour that industry reps and some TM professionals make it out to be? 

When you examine the arguments of proponents, such as OCD's Celia Tombalakian or the research of OCD employees, their arguments do not stand up to scrutiny. They continually overstate how automated testing can improve safety and propose it as magic it is not. 

Companies have a vested interest in promoting automated testing since the business model of cheap razor (instrument) and expensive blades (reagents) is what makes their industry viable. 

Their multi-media advertisements are relentlessly promoted to TM professionals using flawed arguments that show they think they own us and we are their poodles. 


Industry's seeming hold on so many TM professionals brings to mind:
  • You Don't Own Me (Same song re-worked for 2012 USA election - thoroughly partisan. ALERT: Depending on your politics, you may be offended.)
  • You Don't Own Me (Diane Keaton, Bette Midler, Goldie Hawn in 1996 movie The First Wives Club)
Comments are welcome but due to excess spam this section is removed. Please send comments to me personally.

Tuesday, October 09, 2012

The long and winding road - good vibrations (Musings on preparing for career advancement)

This month, I'm pleased to have a guest blogger, one of my 'kids' (former students, MLS grads, all of whom I'm extremely proud of):
  • Lisa Denesiuk, MLT, ART (CSMLS), MLS (ASCP), SBB (ASCP), BSc (MLS)
Earlier this year Lisa moved to a new position with Dynalife Dx and became a Learning Management System and Website Content Specialist. 

Intrigued by her job title, I asked Lisa to write a guest blog on how that came about and what was involved. Despite being a busy health professional, she graciously agreed.

The blog's title comes from an old Beatles song (naturally) and a classic by the Beach Boys. 

Why should you read this blog?
To me, Lisa's career path epitomizes a Louis Pasteur quotation:

  • Chance favors the prepared mind.
  • If you retain nothing more from this blog, remember this.
Educators like to tell students that their undergraduate degrees can take them in many directions. To me, careers beyond the routine are possible only if graduates actively continue to learn both formally and informally, and that takes much effort. 

Continuing education (CE) and continuing professional development (CPD) require commitment to learn outside of work hours, invariably sacrificing time with family and friends or relaxation time. Often it also involves spending one's own money, since today's employers seldom offer financial support to take courses or attend conferences, even if staff present at them.

Going to work each day and giving 100% is not enough. To prepare for future job opportunities, health professionals need to give blood, sweat and tears after hours.

For those of you who want to advance, who want to do something different, yet still use your basic health profession education and training, below is one person's path to an interesting career.

Advice from me to you: Instead of reading the way that busy health professionals usually do (i.e., rapidly scanning and racing through e-mails and websites without content registering in your mind), I suggest you sit back, take a few deep breaths, and focus on slow reading. If you don’t have the time right now, return to the blog when you do.

Slow reading is analogous to slow cooking, an alternative to fast food and something I now practice daily. Reading much transfusion-related news to decide if it’s worth reporting, I’ve had to institute the practice of slow reading. Try it, you’ll like it!

As background, Lisa is one of two former students who were awarded the ACMLT Award of Distinction.

Because she began work in a transfusion service, I followed Lisa's career with interest, as I do all MLS grads, especially those who are employed in transfusion laboratories or blood centres.

As well, Lisa took a CE course I offered by distance education on scientific writing. The CE course was based on a book written as a supplement to MLSCI 320, Fundamentals of Writing for the Biomedical Sciences, later translated into Japanese, as Wakariyasui igakueigoronbun.

Of 100s of participants, Lisa achieved the highest grade. Since this was pre-Internet, the course was an old-fashioned, paper-based correspondence course.

Anyone who has evaluated written papers, essays, and the like, knows that grading them is sheer hell. Which is my way of saying that marking Lisa's assignments was pure pleasure, forever endearing her to me. 

What follows is Lisa's story from bench lab technologist to Learning Management System and Website Content Specialist. Regardless of your current professional role, her narrative has lessons for all.
GUEST BLOG  by Lisa Denesiuk

How did I get here?
It was a long and winding road (Pat will insert appropriate musical link - see later), which is ironic (ditto on an old Alanis Morissette song) because one of the reasons that I chose the medical laboratory profession was that I liked the straight line from finish this program to get this job.

Straight Path
I started out on that straight path, graduating from the University of Alberta Medical Laboratory Science program in 1987 and working (with a few minor detours) for 13 years on the bench in the transfusion service of a busy, inner city hospital.

Twists in the Road
My next job involved moving off the bench and off shift work. I assisted rural transfusion services with maintaining competency and updating procedures and implementing new processes (such as a redistribution program for near-outdate group O RBC). I was a consultant but under the auspices of my employer’s contracts rather than on my own.

Then the off-the-bench road developed more switchbacks.  Another round of healthcare restructuring meant that there was not enough transfusion medicine within my employer’s portfolio to support a full time transfusion specialist.

I had to choose between switching employers and switching career focus.

Fork in the Road
Choosing to stay with my employer, I moved into departments and jobs with difficult to explain titles like ‘Strategic Initiatives’ and ‘Business and Technology Analyst’. 

The beauty and the horror of the coordinator/ analyst/ specialist/ consultant jobs were that I was never quite sure what I would be doing next.  Obviously horrific for someone who likes straight lines, but really beautiful for someone who likes to learn new things.

On a personal scale, my career choices allowed me to develop some advanced software skills (I am still one of the go-to people in my company for advice on making Excel® charts with three axes, though I could never get the hang of pivot tables). I also learned and re-learnt a lot about the non-transfusion laboratory disciplines.

And most importantly, I had to maintain the knack for learning new things quickly (assuming I wanted to stay employed, pay off my mortgage, and continue to supply my cats with organic cat food, which of course is non-negotiable). Which leads to my latest job...

And where is ‘here’?
My new job title is Learning Management System and Website Content Specialist. The font on both the paper and electronic business cards keeps getting smaller and smaller.
The back story. . .
  • My employer bought a learning management system (LMS-software to track learning) and learning content software (LCMS- to build eLearning courses) about 2 years ago.
  • Originally, consultants built our first few courses based on information provided by supervisory and experienced staff members.
  • It took about 1 year to get everything ready for a launch to employees. Then. . .
  • About 2 months before the date set for the launch, the employee in charge of the LMS transferred to another department.
  •   At that time, the organization decided to bring the course building in-house. So the ‘team’ was reorganized into one ‘content specialist’ (i.e., laboratory geek) and one ‘developer’ (i.e., IT geek). I’m the lab geek.
Needless to say with both of the team members having < 2 months to learn the LMS themselves before explaining it to 1100 employees (> 500 in one-on-one sessions), our first few months on the job were hectic!

Why was I the ‘chosen one’?
  •   Served on the committee that investigated eLearning providers and suspect that the questions asked during this process demonstrated an understanding of life-long learning and a passion for the topic. (Likely the main reason the position was offered.)
  • Gained much informal teaching experience in my laboratory career, but current boss was probably unaware of most of it.
  • Discovered early that I loved to teach and succeeded at it. Almost from the moment my probationary period ended, I was a preceptor while on the bench.
  • While a TM consultant, I often gave review sessions to staff in the rural hospitals and presented at conferences.
  • Participated in continued professional development in various formats over the years, but again current boss probably didn’t know about that. 
A self-confessed CE junkie, I’ve added several letters behind my e-signature:
SBB blended program (2 weeks on-site within a full year course of distance education) from the University of Texas Medical Branch.
Took instructor-led courses, paper-based distance courses, electronically delivered courses, blended courses, courses for fun, courses for work, courses for professional development ... name a course type and I have probably taken at least one example.
Also volunteered a lot for professional organizations, which is an amazing source of informal education. Plus you get to know the most incredible fellow laboratorians.
Unexpected Opportunity Knocks
You never know what unexpected opportunities will develop from something that seems straight forward. I finished the UTMB course, passed the ASCP SBB exam and went back to my life.
Then a couple years later I was asked to write the ABO chapter for a new transfusion textbook, because my SBB instructor recommended me to the book authors. I wrote the chapter and then a couple of years later was asked by the book authors if I would like to become the fourth co-author on the textbook because they were stuck and needed some change to kick start the project.
And several years later we are on the final push to meet our deadline so the first edition can hit the shelves in June 2013. And for the last few months I have been in charge of developing the figures. All of a sudden I can do intricate stuff in Visio® because years ago I took an SBB course, not an obvious outcome.
What does a content specialist do?
My core function is as interpreter. . . I’m the go-between for the subject matter experts (SMEs) and the developer. To illustrate, my position includes:
  • Listening to what the SMEs want.  Love this acronym. Doesn’t it conjure a picture of a scholastic smurf-like creature? I often have to hone their focus to something manageable.
  •  Investigating the topic, then building a storyboard (think PowerPoint® with notes about animations, pictures, pop up boxes, rollovers, etc.) and an exam question bank.
  • Facilitating the review by SMEs and, after tweaking, handing the storyboard over to our developer (IT geek) to build the eLearning course.
  • Helping if the developer doesn’t understand some laboratory-specific process or jargon or what my storyboard notes mean.
  • Coordinating the course rollout to appropriate staff members.
Concrete example:
  • SME’s manager: ‘We want to reduce our data entry errors.’
  • Me to the quality department: ‘What are the 3 most common data entry errors we see?’
  • Me to the SME: ‘Can I sit in on your 2-day in-person training session for newly hired laboratory assistants?’
  • Me to the IT geek: ‘Here is the first of 3 storyboards about data entry - it is all about entering patient demographics correctly.’
  • IT geek to me: ‘Do you really want to say Order a DPHON on this slide or is this some bizarre typo?’....Reply:  ‘Yes, that is a comment that our laboratory information system recognizes and it translates to …and the laboratory assistants will know what that sentence means.‘
  • Me to the LMS via writing an ongoing rule: ‘Enroll all laboratory assistant IIs who work in patient care centres in the first data entry module.’
What do I love about my job?
  • Getting to teach again
  • Opportunities that electronic learning presents
  • Great potential to help our staff members, who are geographically scattered
  • Learning or re-learning many different topics
  • Working with new technology and coming up with creative solutions to obstacles
What I don’t like about my job?
Unfortunately, I’m
  • Sad when hearing that staff members see eLearning as an imposition rather than a benefit.
  • Frustrated when the priorities we work on change after every meeting and consequently for months nothing ever seems to get to the finished product stage.
Most frustrations relate to being in the midst of a cultural change. Half the management and executive team seem to see eLearning as the magic pill that will cure all ills and the other half are not convinced that time, energy and money invested in the system will result in a good return on investment. 

I’m sure the reality will fall somewhere in the middle, but in the meantime, we are caught between widely divergent, and often unrealistic, expectations.

My own learning journey
Besides the obvious learning of new software systems and relearning of laboratory topics, my employer is supporting my pursuit of a Certificate in Adult and Continuing Education (CACE).

What if you wanted to become a learning content specialist?
  • Structured programs about building eLearning (IT geek part) and about delivering adult education (lab geek part) are expanding. Consider taking a few courses.
  • A content specialist requires strong communication skills as the bedrock, and experience is the best top soil. (What I bring that the consultant could not was credibility with the SMEs. Being able to talk the lab talk goes a long way to smoothing over differences of opinion). 
  • The mulch in the metaphor is being able to learn both lab topics and new software quickly.
  •  My best advice is to be open to opportunities, which often cloak themselves as ‘more work projects.’
As noted, the blog's title derives from these songs
Comments are most welcome BUT, due to excessive spam,  please e-mail me personally or using the address in the newsletter notice. I’d love to hear how you prepare to advance and expand horizons beyond the typical career ladder. 

Sunday, September 09, 2012

I heard it through the grapevine (Musings on transfusion professionals & Twitter)

Significant additions in green below: 12 September, 2012
'What is Twitter and why should I care'
'Examples of fun ways to use Twitter at a conference'
This month's blog is about an item on my wish list:
  • That more transfusion professionals get involved with social media, specifically with Twitter
It's not a request for professionals to join Facebook (which many already have for personal reasons), as FB is too into selling its users to advertisers. I'm not a fan of FB as those who read my tweets will know, as shown by this blog:
The blog's title is from a great pub song by Creedence Clearwater Revival, I heard it through the grapevine.

I'm a Twitter fan and currently have multiple accounts, including
@transfusionnews | @bogeywheels | @eurofutball 
More specifically, the blog is a plea for transfusion service entities* to create a twitter account to share news, initiatives, innovations, thoughts about anything transfusion-related.
* Laboratories - individual or regional labs, preferably the former
* Canada's provincial blood offices or equivalent
* Transfusion professionals (docs, nurses, technologists, recruiters, you name it)
Twitter, created by the guys who created blogger, functions as a grapevine and is a great way, perhaps the best way, to learn quickly about 'what's happening'. For example:
  • Watching the recent Republican and Democratic conventions on television was a blast, significantly enhanced by following tweets in real time on Twitter. I've interacted with journalists from the CBC, Ottawa Citizen, Toronto Star and and others I'd never talk to in real life. 
  • When my favorite UK Premier League team Chelsea plays, it's great fun to participate via Twitter. I'm exposed to many opinions and learn much about the niceties of football (soccer in NA). Reading the tweets of players adds another dimension.
  • Those followed with @transfusionnews regularly post health, laboratory, and transfusion news I'm interested in, and often before it appears in local papers. 
If you're a news junkie, as I am, Twitter cannot be beat. As Number 5 from the movie Short Circuit said, Input, more input! 

See Twitter's creator describe its beginning and many uses on TED.

Consider the possibilities for transfusion medicine. I'd love to learn in real time (or close to it)
  • Current issues and concerns in local, regional, national, and international  transfusion services, unfiltered by the powers that be 
  • What's on the minds of transfusion leaders and trench workers around the globe
And in the process, participate in the extended interactive conversations that Twitter facilitates.

The medium allows people to network beyond their normal social and professional spheres. It's an effective way to connect with people who share your interests.

Similarly, professionals can alert others to web and other resources that can be shared. See my favorite sharing pic.

Yes, I know, 140 characters is limiting. But it's amazing how the need for brevity focuses the mind. And you can always link to photos and existing web-based resources.

If you're into censoring staff and worried about your corporate image, Twitter is probably not for you, at least not without spending time and effort to filter posts through the corporate mindset.

But why not be loosey-goosey, instead of anal-retentive, and credit staff with judgement? 
  • All it takes is to develop a few guidelines on what can be posted without being vetted. 
  • If staff make life and death decisions, surely they can tweet about a technical or clinical problem or ask for advice on what others do or share a resource without corporate approval. 
Many Internet-based  resources exist to help us in our work, inc. e-mail, mailing lists, and web-based forums. Twitter is another that currently is under-used.


Will Twitter be adopted by transfusion professionals anytime soon? I doubt it. Obstacles are many, including
  • Internet skills and fears of some (not all) transfusion professionals;
  • Over-arching control by organizations that want to control an employee's every move;
  • Twitter, a newcomer to social media, is not yet widely adopted by all those who initially embraced Facebook;
  • Belief that social media is fluff, not serious;
  • Elitist tendency to debunk anything that is not evidence based and preferably proven by a RCT;
  • Reluctance to participate, based on view that participating is not worthwhile and has a poor ROI (return on investment);
  • Too busy, the current all-purpose excuse for not doing anything (even continuing education) beyond meeting basic job duties.
It's easy to join Twitter. You can lurk (as most do on mailing lists) and participate as the mood strikes. 

Please consider giving it a try. For those unfamiliar with Twitter (added 12 Sept. 2012):

What is Twitter and why should I care?
In brief, Twitter is a service (mini-blog) to post text messages of 140 characters or less and share information with many people. The idea is to create groups of people ("followers") who are interested in a given topic, indeed any topic, whether it be politics, football, or transfusion medicine.
Message can be just text or include one or more links to websites. You can also add an image.
You can read the posts of Twitter users without joining but you need to know their Twitter names or addresses, e.g., @transfusionnews (http://twitter.com/transfusionnews)
The way to use Twitter effectively is to create an account and "follow" your favorite users for the latest news of interest.
How Twitter works: Your messages (if you make any) - called tweets - show up on your main Twitter page ('profile' or home page). If other users, (nicknamed tweeps) "follow" you by clicking the Follow button on your page, your messages will show up on their home pages.
Conversely, if you "follow" another user, their messages show up on your page. That way, when you login to your Twitter page, you can see tweets from many users at once. You only follow those who post things you're interested in, and you can un-follow someone at any time.
The way to group messages on a given topic, and allow people to find them, is to place a hashtag (#) directly before relevant keyword or topic. For example, you could use #transfusion to help others find transfusion-related posts:
Interesting case study on a student error in a #transfusion service lab resulting in a hemolytic reaction and death http://goo.gl/OjCP5
Examples of fun ways to use Twitter at a conference:

  • If it had existed at the 2002 ISBT World Congress in Vancouver: I'd have loved to tweet on which exhibitors had the best hot hors d'oeuvres or where the best inexpensive breakfast could be found at a diner near the convention centre.
  • Exhibitors could tweet on the freebees they offered at their booths, the kind of loot that rabble like me like to gather as mementos.  Maybe it could stimulate even better swag to be on offer?
  • The hashtag #nobgnosh could be used to identify in real time which 'notable nobs' were lining up with which exhibitors and where for the ubiquitous free dinners for clients and which restaurants were on offer. Hmmm. Who did I know well enough to I tag long with? Did I want to gnosh Chinese, Italian, or East Indian and with whom? Choices, choices....
  • Those of us arriving late for the first sessions of the morning (hey, it happens) could be helped if those inside sessions could tweet on which talks still had seats available. As someone unable to stand in one place for long, this would be a godsend. 
  • Would be fun to tweet in real time about a speaker's presentation. The talk and speaker could be exemplary, but here's an example of another type seen all too often at major conferences, e.g., for hypothetical Speaker "A', a way to keep awake: 
  • OMG. He's reading every word on his PPT slides and the bullets are complete sentences. 
  • Never saw so many words on a slide before. LOL 
  • Can't believe he just said, 'I apologize for this slide. I know it's hard to read.'
  • That's the 18th time he's said, "Okay" softly under his breath and still 20 mins. to go. Only 10 "ums' so far. Ringing bells!
  • Would be neat if in a central area or two, there could be large screens with relevant tweets for all to read, e.g., last minute change of venue, which local tours are still open. The possibilities are endless.
More and more people and organizations use Twitter, which only started in 2006 and now has 100s of millions of users. Even diplomats do it: Twiplomacy 

To discover more on Twitter and how to sign up, search for "how to use twitter".

Enjoy these songs, circa 1970, from legends of the era:
Love Tina's version at Rio de Janeiro concert (part of her 1988 Break Every Rule tour) with over 180,000 spectators, one of the largest concerts ever:
  • Proud Mary (Tina Turner, 1988 - 1st 'covered' in 1970 with her then husband, Ike Turner)
As always the ideas are mine alone. Comments are most welcome, BUT, due to excessive spam, please e-mail me personally or use the address in the newsletter notice. Be sure to read those below.

Friday, August 10, 2012

When sweet dreams become nightmares (Musings on health officials & Big Pharma)

Updated 17 Sept. 2012

August's blog is stimulated by disappointment, even disgust, with those associated with health care who turn out to be dishonorable, i.e., liars and thieves who put their welfare above those they serve.

Would be nice to write a cheery, upbeat theme for the dog-days of summer (in northern hemisphere), but recent news items are enough to make me, and I'd guess most readers, gag.

Regardless of your location, the blog has much food for thought because the issues are global. Honest, you could not make this crappy behavior up.

The title comes from a song by Annie Lennox, a Scottish singer-songwriter and political activist.

These events happened in my backyard but I know it could happen where you live and probably has.

The gist of this sad tale is that Allaudin Merali, hired by Alberta's provincial health system (AHS) as CFO in May 2012 at a salary of $425,000, resigned in July after a CBC reporter broke the story of his exorbitant expense claims ($346,208).

The expenses occurred during his previous employment with Capital Health (before AHS was created) as its CFO (Jan. 2005 - Aug. 2008). For interest, a CFO's responsibilities.

Is Merali an outlier? I suspect not. This type of abuse had to be normal for the health system or it would have been flagged and stopped.

The health region's CEO kept signing off, and who knows for how many others pigs at the trough. You know, all the senior political cronies (oink! oink!) our provincial government appointed to make decisions for us, invariably with minimal or no input from health professionals in the trenches.

To think that my colleagues and I would never include liquor in our expenses (makes sense as it's discretionary spending and not allowed). We'd fly the cheapest airfare, as required, despite inconvenient schedules like red eye flights. Being good employees with integrity, we'd meticulously  use time-inefficient airport shuttle buses so as to keep our expenses minimal in the interest of fairness to those paying.

Not this Merali dude, though. And to top it off, after losing his job in 2008 (when Alberta's health system was reorganized), he received $1 million in severance and a $1.6 million retirement plan over 10 years ($13,303/mth).

17 Sept. 2012: AHS chair whines on cost of audit & info requests into executive expenses (Ya gotta love these guys)

Pretty sweet, eh? (Said the Canuck with a grimace, not a smile.)

News items:
Fascinating stuff. Many routine charges (e.g., conference registration), but who knew the nobs also charge for booze? Fact is, Merali, earning a substantial salary, charged for everything. I bet if he bought a small packet of kleenex or gum drops at the airport he'd have charged them. 
It's a saga of greed and privilege rampant at the highest levels of a health care system. Leaders are supposed to model expected behavior and instill confidence in a shared vision to benefit all. Gak!

The behavior of this particular Alberta health official falls so short. But he cannot have been alone. If you or I behaved as Merali did (and who knows who else at the top did), we would not, indeed could not, get away with it. Adding to the odious conduct, the situation indicates a double standard that undermines the entire system.

At the same time as Merali was at the trough, Alberta's health professionals struggled to do more with less, as did the entire health care system (too few staff, too few beds, too few long-term care facilities, etc.)

During this time (2005-8), when lunching at a nearby hospital I'd occasionally talk to laboratory technologists who were former students. When asked how things were going, they'd invariably reply anything from not good to brutal.

My next question was, "What's the main issue?" The reply was always a variation of, "Too few staff." So few, that existing staff could not take holidays as there was no funding for part-time or casual staff, even if suitable replacements existed.

Once a PhD lab director stopped by and looked positively ashen. In conversation he noted that what was happening (Alberta's restructuring from multiple health entities to one) was even worse than the 1990s when cost cutbacks were severe and uncertainlty reigned:
One lab technologist told me that they had a gag order not to talk to outsiders on threat of firing. If Alberta's physicians were bullied, you can bet everyone in the system was.

Charming. What a way to run a health system.

As cost restraints prevailed in the trenches, Merali (and who knows which other senior health officials) was living the high life at tax payers expense. Dining at the most expensive restaurants, getting a phone installed in his Mercedes (Who does this in the age of cell phones?), repairing his Mercedes. It must have been hard to rack up almost $350,000 in expenses over 3 1/2 years.

Is this narrative unique to Alberta, Canada? I doubt it. My take is that it's happening somewhere near you, but you may not know about it yet or ever, unless you have professional reporters who can investigate.

And we know what's happened to real reporters in print journalism in the Internet era. Sites that compile news have gutted the system and users expect news and everything else on the Net to be free.

Big Pharma presents a similar tale of corruption, indeed a worse one. Seems reports of bribery and putting corporate benefit above vulnerable patients never stop.
GSK admitted misbranding 2 drugs and withholding safety data for another:

GSK had total disregard for the health of vulnerable people they were supposedly helping - knowing their actions could cause harm, but doing it anyway for self-advantage.
If I did that as a health care professional, I'd be guilty of criminal negligence.
With USA regulators clamping down, drug firms seem to have stopped (I say seem because who knows) perks for doctors and similar bribery. But not so in developing countries.

Pfizer's conduct seems to be normal for Big Pharma. 8 of the 10 biggest firms on the planet mention costs for corruption charges as a risk.

Big Pharma's behavior is similar to tobacco firms selling cheap disease-causing cigarettes in developing countries, not caring about those who die. With a decrease in sales in industrialized nations, multi-national companies in the UK and USA decided to spread smoking to developing countries:
Or take the case of our Canadian government (the Harper government as they like to be called), which for a few jobs in Quebec in the asbestos industry, refuses to support a global ban on the well documented killer, asbestos:
Shameful. Disgusting. Sickening. Criminal. Tobacco companies, Canada's Harper government, and drug companies  - all behave similarly.

The spectre of senior health officials in my province and their culture of privilege is one thing. I expect it's the same whether in countries with national health care systems (most of the world) or the USA, where private health competitors do whatever it takes to survive and make profits.

What also gets me is that I know several industry reps who are decent individuals. It's hard to think that they work in an environment where bribery and lying are normal. But to think otherwise would be naive. Sadly, evidence to the contrary abounds.

When first entering the health professional many years ago, I had dreams of helping others and being one of the good guys. Definitely a profession that was a notch above used car salesmen, who had a well deserved reputation for lying and cheating customers. But I've learned that health care is also a business, and a nasty, nightmarish  one.

What to do? Focus on the positive in daily work, shine a light on the rats among us, and hold those who tarnish the field to account, a lifelong challenge. Or say nothing, do nothing, be nothing?

Can there be any fun after such all too real events? Of course. First, a great song that outlines the reality described above:
  • Sweet dreams (Annie Lennox) Some of them want to use you...Some of them want to abuse you...
Next, a slightly sappy 1960s ditty that expresses what we hope for all those involved:
Lastly, to end on a positive note, and just because I love the song and its fabulous artist appears at the Edmonton Folk Festival this weekend:
As usual, the views are mine alone. Comments are most welcome BUT, due to excessive spam,  please e-mail me personally or use the address in the newsletter notice.  Great comments below - be sure to read them.