From crisis to trusted partner in healthcare delivery:

The transformation of Canada’s blood supply system – past, present, and future

ORBCoN Spring SymposiumToronto, March 24, 2012

Dr. Graham D. Sher, MB BCh, PhDChief Executive Officer

Canadian Blood Services

Outline• Legacy• Picking up the pieces• A journey of transformation• Building for the future – an integrated blood system• Strategic shift• Challenges and opportunities• A trusted partner in healthcare delivery

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Legacy

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• Tainted blood: greatest public health crisis in Canadian history

• 2,000 HIV infections• 30,000 HCV infections• C$ 2.7 billion in

compensation

Legacy

• Pockets of excellence and compassionate care overshadowed by systemic failure– Poor decision-making– Inadequate funding– Insufficient governance oversight– Lack of accountability– Inability to respond in a timely manner

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Legacy – Krever Inquiry

• Federal government determines need for a commission of inquiry

• Justice Horace Krever, appointed by Order in Council, October 4th 1993– to review/report on mandate, organization,

management, operations, financing and regulation of all activities of the blood system in Canada

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Krever’s gift to Canada and the world

• Krever recommendations are foundation for today’s blood system in Canada, and elsewhere

• Remains the single most important prescription for modernization of blood systems internationally

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Justice Horace Krever, recipient of Lifetime Achievement Award, Honouring our Lifeblood 2008

Krever’s recommendations

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Picking up the pieces

• New “National Blood Authority” created via Memorandum of Understanding

• Roles of CRCS and CBA in the blood system are terminated• Canadian Blood Services (and Héma-Québec) assume

ownership and responsibility September 28, 1998

• Not-for-profit, charitable organization• Funded by provinces, regulated by Health Canada

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Picking up the pieces

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The system today

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Canadian Blood Services at a glance

Governance

A journey of transformation

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So, how did we get here?

Explicit transformation of purpose

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Transformation journey

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Building for the future - an integrated blood system for Canada

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Progress report

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Safety

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2007Bacterial detection 2007Bacterial detection

Safety remains paramount

Investment in safety goes beyond protection from TTHAs

automation, process control, quality culture, surveillance, knowledge, innovation etc.

Safety remains paramount

Investment in safety goes beyond protection from TTHAs

automation, process control, quality culture, surveillance, knowledge, innovation etc.

Future challenge of increasing costs of safety initiatives for increasingly small safety gain

cost benefit analyses essential

“acceptable risk” rather than “zero risk” paradigm

Future challenge of increasing costs of safety initiatives for increasingly small safety gain

cost benefit analyses essential

“acceptable risk” rather than “zero risk” paradigm

Security of supply

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Demand for fresh components volatile

Demand for derivative products continues to increase unabated

Multi-pronged approach focusing on recruitment, retention, loyalty, product wastage, diversity of supply

Real time demand forecasting

“Collect what the system needs, not what we can”

Service Delivery Model

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Silo modelIslands of duplicationLimited integrationLimited redundancy, backup or business continuity

National integrated supply chainSingle inventoryShared services modelConsolidation of key functionsHigh level of business continuity and redundancy

Productivity & Efficiency

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At transition, significant under investment in core systems, processes, people and infrastructure

necessitating steep increases in revenue in early years

cost of reasonably “affordable” system unknown

At transition, significant under investment in core systems, processes, people and infrastructure

necessitating steep increases in revenue in early years

cost of reasonably “affordable” system unknown

Year-over-year increases in funding have steadily declined below the general healthcare rate

Major operational efficiencies: Collections / employee – compound annual improvement of almost 12% since 2000

Operational effectiveness has increased. Collections have a compound annual growth rate of more than 24% since 2000

Year-over-year increases in funding have steadily declined below the general healthcare rate

Major operational efficiencies: Collections / employee – compound annual improvement of almost 12% since 2000

Operational effectiveness has increased. Collections have a compound annual growth rate of more than 24% since 2000

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Sustained drive for efficiency

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Other major changes

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Trust

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• System transformation and “walking the talk” on safety has regained trust

• Trust is fragile, and must continuously be earned

Strategic shift

• Leveraging our capabilities to solve other healthcare challenges:

– National umbilical cord blood bank– Organ and Tissue Donation and Transplantation (OTDT):

• Registries• Leading practice • National strategy

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Not just blood anymore…

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current

new

Prior to launching OTDT, we had independently determined we needed to transition to business line management to better serve the customers of each business line

New horizons

• The case for cord blood:– Canada one of few industrialized nations

without national public cord blood bank– Growing utilization - >900 Cdn patients

currently waiting for stem cell transplant– Better respond to Canadian patient needs

• ethnic diversity (aboriginal, mixed ethnicity, etc)

– Reduce reliance on imports, reduce costs to Canadian healthcare

New horizons

• The case for change in OTDT– Despite pockets of excellence, Canada as a country is not

realizing its full OTDT potential– Canadians are supportive of organ and tissue donation,

but the system is failing them– The system has inefficiencies, lacks equity, transparency,

and sustainable funding to drive break-through performance

New horizons

• Donation rates nationally have stagnated for a decade

• Organ donor rates are less than half of the world’s top performing countries (Canada ranks just behind Lithuania)

• Reliance on imports for tissue• Provincial service delivery model is “shackling” the

good work of healthcare professionals in the field

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1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Key Indicators

Waiting List Transplants Donors

Donation and transplantation performance have not been improving. In 2009, 249 Canadians died waiting for an organ transplant.

Performance data - organs

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Sources: Canada: CORR e-statistics; International: iRodat

There has been no improvement in preventing deaths on waitlists for any organs for the last three years.

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32.1

*ONT (Spain), UNOS (US), NHSBT (UK), Donatelife (Aus), CIHI/CORR (Canada)

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International experienceDeceased donors per million population (2010)

Reducing wait times

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Call to Action Targets:An increase of 50% in donations, resulting

in over 900 new transplants annually by Year 5 of the plan.

Call to Action Targets:An increase of 50% in the supply of corneas

resulting in an additional 1,100 transplants annually by Year 5 of the plan

Current State — Canada vs. USA

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*Data estimated from 2007 to 2009 EBAA, AATB, and CBS statistics)

Attempts to improve performance

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Volpe Report

DM Report/ ACHS

CCDT merges with CBS

CCDT established

NationalCoordinatingCommittee

Alberta Framework for

Action

Citizens Panel (ON)

CDM Report/ CCDT

QC Minister/ CEST

New horizons – some early advances

• Organ registries:– Living Donor Paired Exchange

• partnership between transplant centres and Canadian Blood Services

• Pan-Canadian• 100+ transplants facilitated in past 2 years

– National Organ Waitlist– Highly Sensitized Patients

New horizons

• OTDT national strategy:– Call To Action delivered 25 recommendations on how to

significantly improve performance– 3 years worth of consultation, dialogue, and planning with

experts (domestic and international), professional associations, patients and patient groups, governments and other stakeholders

– Delivered to FPT governments April 2011– Impact assessments ongoing , decision

pending in 2012

Challenges and Opportunities

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Challenges and opportunities

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International trends in blood systems

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A trusted partner in healthcare delivery

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A trusted healthcare partner

• Viewing the blood system as an integral part of the healthcare system

• Our value proposition is partnership in healthcare delivery

• Over a decade of experience in complex health system transformation:o Leverage the lessons learned:

service delivery integration healthcare sustainability national pharmacare in micro

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A trusted healthcare partner

• We have a lot to offer when it comes to being part of national health policy discussions.

• Proven and unique experience in operating a nationally integrated system, best practices and learnings to share with others.

• Real opportunity for Canadian Blood Services to leverage its national, pan-Canadian, integrated, delivery expertise

Conclusion

Paradigm shift:•From crisis to confidence•From single-focus to multiple business lines•From risk aversion to risk-based decision making•From monopoly, to stewardship – continually earning the right to serve•From service provider to trusted partner in patient care

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Questions