Saturday, February 07, 2015

Islands in the stream (Fun musings on TM's crusade to cut costs - there's an app for that!)

Updated: 14 Feb. 2015

This blog derives from an article in the Jan. 3, 2015 issue of The Economist:
The blog is a follow-up, a sidebar in newspaper parlance, to a blog I wrote for TraQ's January newsletter:
The earlier blog discusses the rancor and over-the-top claims that can occur during contract negotiations, especially when employers such as national blood suppliers consistently opt to cut costs by hiring cheaper, less educated staff.

The current blog muses on HR 'what ifs' related to saving money by using outsiders and training remaining staff 'on the cheap' using apps. The tone is irreverent, the content tongue-in-cheek. If you're offended, don't be.

The blog's title derives from a 1983 Bee Gees song. The Bee Gees were the brothers Gibb, born on Isle of Man, who sold more than 220 million records worldwide.

#1. What if...
CBS, Canada's national blood supplier, expanded its Donor Care Associate initiative ('multi-skilled clinic employees' perform all clinic functions, from venipuncture to donor screening, tasks previously done by RNs) beyond nursing to transportation?

In northern climates I envisage 'Transport Care Associates' working for blood suppliers such as BFDC ('Blood Fluids Dot Ca').

In tropical climates, perhaps turtles, slow but steady and reliable?

#2. What if...
An equivalent to Amazon's 'Mechanical Turk' existed for transfusion services?  Why not a global blood bank work force where transfusion medicine specialists 

  • Work from home
  • Choose own work hours
  • And no one needs to pay for their benefits except them
  • National blood suppliers would crow to government paymasters, 'Look how we've decreased costs.'
  • Not mentioning on whose backs savings were realized and probably increasing the CEO's salary for his great work
Let's call it 'BB-a-Go-Go' with these business lines:
  • BBaGG-IH: Want expert help with an unexpected crossmatch incompatibility, complex antibody identification, blood grouping conundrum, any immunohematology challenge? 
    • Get these IH folks fast as they're a dying breed.
  • BBaGG-Scribe: Need experienced SOP writers or help creating a blood contingency plan to deal with severe blood shortages from pandemics and other disasters? 
    • They'll create e-text files. Bonus: Older Scribe staff will produce notes in readable cursive writing in the margins of existing documents. Yes, really!
  • BBaGG-Consultants: Looking for 'suits' to down-size the organization or decimate it by out-sourcing tasks to for-profit firms, then flee the ugly aftermath? 
    • Our 'suits' don't clean up the detritus of the 'past civilization' but we can supply grief counsellors for a fee.
  • BBaGG-RN: Seeking advice for how to tame and educate pit-bull nurses refusing to re-draw mislabelled specimens? Typically, the RN's dialogue proceeds as follows:  
    • 'I know I took blood from the right patient.'
    • 'Don't you know you're risking the patient's life with your stupid lab rules?'
    • 'The poor patient has been "stuck" 4 times today already!'
For an extra fee, we offer the online RN-tailored course, 'Quality Control, what's it all about, Alfie?'
  • BBaGG-Dominatrix: Desperate to neuter abusive docs who insist on blood now, who don't care about your 'bloody positive antibody screen nonsense', just want group O RBC NOW, because they were told in med school group O was the universal donor, safe for all?
    • With Dominatrix Plus, the physician gets a safe word or phrase to indicate they cannot take it any more. We suggest 'Lab uber alles' or 'I'm lab's poodle'.
Other 'BB-a-Go-Go' business lines are possible. Feel free to suggest some in Comments.

#3. What if
A smartwatch app existed that included all the pre-administration checks that a nurse must do before administering a transfusion? Let's call it 'Last Chance':

  • The watch has a camera that monitors the checks, and beeps if one were missed, identifying the missed detail. 
  • A nursing manager  - for fun, the spitting image of Nurse Jackie - pops up on the watch's screen and gives a video message about what to do next and why you better do it NOW. 
  • The bedside nurse can reply and ask questions with a video message in return. 
The app could also include built-in alerts to check the patient during and after the transfusion.

With bulk purchases, buyers get the add-on, 'Doomsday Clock', which shows how close to midnight it is, indicating how close the nurse came to an OMG! patient disaster.

#4. What-if
An app existed that allowed instant access to transfusion medicine experts, 24-7? 

Say you're a hematopathology/hematology resident on-call and the biomedical scientist / lab technologist calls with an issue you've never heard of. Chances are she or he knows more than you but you can never admit it.

You could call the transfusion service medical director, yet again, further digging your own grave, or you could use this 'killer app',  PMA ('Protect My Ass') for medical residents. Currently, versions exist only for Blackberry and iOS phones, plus iOS tablets.

Wait, there's more! PMA includes a simulation of how residents can learn to be obsequious to RNs on the wards, bowing to their superior knowledge and experience, and learning from it.
The Economist's piece expertly analyses the pros and cons and obstacles to the ongoing trend of on-demand freelancers who work without job security, without benefits, without pensions.

That's where national blood suppliers like Canadian Blood Services are heading. It's a trend everywhere.

My view is the trend is inevitable but not progress, not admirable. And, as The Economist points out, a freelance work force doesn't contribute to happy staff who consistently give their all for employers they love and respect, and whose success is tied to theirs.

BUT the trend exists because .... [you fill in the blank] 

Wish List: I'd like to see an app that translates management's weasel words into what they're really saying. One example: 
  • 'We're pleased to report a "cost saving" of ...' probably means,
    • We've eliminated expert frontline staff;
    • Replaced them with less educated, cheaper staff; 
    • Perhaps replaced them with automated equipment, likely sending money to a foreign international company rather than hiring local staff and keeping wages in the community;
    • And given execs a bonus and pay raise for their brilliance in decreasing costs.
This duet of the Bee Gees song is perhaps the best country duet of all time. One of my favorites, the song fits what I see the transfusion medicine community should be but isn't. The lyrics also suit upcoming Valentine's Day.

Islands in the stream
That is what we are
No one in between
How can we be wrong
Sail away with me
To another world
And we rely on each other....

Not a disco fan but this Bee Gee ditty from 'Saturday Night Fever' with John Travolta is irresistible. Also relates to TM workers in era of cost restraints:
As always the views are mine alone and comments are most welcome.

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