“Saving Blood, Saving Lives” is an innovative strategy to improve rational blood product use and save both blood products and money in the resource limited setting. The project has been recognized for its innovative strategies and ability to improve service delivery. The project has hard evidence of blood saved, reduced cost of delivering services, and ability to be replicated. Hospital savings have been used to enhance service delivery with the employment of healthcare workers to help with the heavy burden of patient care. The innovation is the use of a form (an "accountability form") and video presentations to change clinicians’ behaviour. Similar to the effect of Dr Peter Pronovost's checklists, our blood accountability form, monthly audits, and improved communication through electronic media helped to surpass our goals, saving both lives and money. Simple, cheap and hugely successful – the accountability form concept has been tremendously successful.
Why the innovation was developed
Blood products are lifesaving, but they are both an expensive and scarce resource (there is a national blood shortage crisis). Edendale Hospital was deemed one of the worst provincial performers in terms of the amount and cost of blood products used, misuse and ordering of products, this despite having a blood bank on site at the hospital.
We were also aware that the misuse of blood products was widespread not just at our own hospital resulting in unnecessary use, wastage of a precious resource, and potential harm to patients.
The challenge was to figure out an innovative strategy to ensure the correct use of blood products, decrease the amount of blood products used, and reduce expenditure – all of this without spending any money no budget was available.
Enhance transparency, Improve access, Improve effectiveness, Improve efficiency, Improve service quality, Improve social equity, Improve user satisfaction, Other, Support economic growth
General population, Government bodies, High-risk populations
The hospital blood bank is bale to process requests faster because of the decreased workload and decreased number of unnecessary requests and tests.
Clinicians are able to get blood products more efficiently for their patients and thus provide a better level of care.
Accessibility has improved before the project started we would regularly run out of blood products at the hospital.
That has now changed and we actually move blood out from our hospital to other areas in need.
The project has thus improved our patient's accessibility to this lifesaving measure.
Again, the reliability of both the blood banks ability to provide blood products and the speed at which this occurs has been improved by the project.
At Edendale Hospital alone we have saved 4400 units of blood over 24 months which is enough blood to supply the maternal patients in Mpumalanga province for an entire year.
Edendale Hospital has saved R15.3 million (adjusting for year on year inflation of 7.5% and 4%) which has contributed to the employment of more staff and better services for our community.
Results not available yet
Dr Wise- frontline staff - together with the Hospital Transfusion Committee.Design time: 2 month(s)
The project was planned for 3 months before implementation. This included literature searches of scientific material to ensure our hospital policy for blood product utilization was in keeping with international evidence.
We had no budget to work with and still require no additional funds to run the project. The accountability form was trialed and tested before implementation as was the hospital transfusion policy, through rigorous debate and discussion among hospital specialists and head of department.
Collaboration with the hospital blood bank was essential and included at every step.
Testing time: 1 month(s)
The project was based around principles to change people's behavior in a positive and constructive manner.
Principles expressed by several behaviouralists/ authors were employed as strategies. There was no technology used as we work in a resource constrained environment with no budget for the project.
Communication was achieved through basic prerecorded PowerPoint presentations and distributed on DVDs across the hospital.
Resources were predominantly staff and time. We did not have any money for the project. Online literature searches were performed to gather scientific literature.
Implementation time: 1 month(s)
Outreach has been done for the last 14 months both provincially and nationally. The project has also been disseminated as part of the Saving Mothers Campaign to 6 of the 9 provinces.
Multiple awards have raised the profile of the project. SANBS and the CPSI have both supported multiple provincial and national outreach and replication events.
The project has been present at the National Blood Congress, the South African Anaesthesia Congress, and the CPSI Innovation Congress.
Diffusion time: 20 month(s)
Challenges and solutions
Several challenges have been overcome, particularly in the development of the protocol, communication, learning how to change peoples’ behaviour, and in the designing of the innovative accountability form. The protocol has been revised on multiple occasions to ensure practicality, pragmatism, and safety.
Communication in a large 900 bed regional hospital is challenging, and it was important to get the same message out to every staff member to avoid confusion, ambiguity, and misunderstanding. We learnt that a video presentation with a prerecorded audio was the best method and worked well.
We learnt that it is possible to change clinician behavior through simple measures such as “making them rethink” decisions through an uncomplicated form, and holding people accountable for their decisions through appropriatefollowup. “Design – test – and then redesign” was required to ensure the best possible accountability form.
The project worked through the targeted end users at every step with involvement of all Heads of Departments, discussions with departmental specialists, hospital management, hospital policy and procedure committee and the hospital transfusion committee. In addition, the hospital blood bank and SANBS were involved at every step as their support was critical.
South African National Blood Services & Centre for Public Service Innovation Other, Other Public Sector
Both the partnerships have helped developed the project provincially and nationally, with support for replication and further innovation. The SANBS have pledged to support establishment of national preoperative transfusion guidelines to further improve the responsible use of blood products.
Innovation does not always require technology and it doesn't always require money.
Simple innovative changes to management systems can have far reaching effects and influence nations if you are persistent.
The concept of collective genius/ collective innovation and working within a team and community is vital for success.
Conditions for success
Perseverance and dedication
A Hospital Transfusion Committee with a team and team leader ready to work hard for 36 months.
Support from hospital management and the local blood product services.
The abilities to adapt, remain flexible, and keep your eyes on the prize.
Within the next year we hope to have the project running in at least another 15 hospitals. Eventually, this project will solve the blood shortage crisis facing South Africa, and contribute hundreds of millions of rands to improving the health services for our low-income patient populations.
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