Dr Manisha Shrivastava (M.D. Transfusion Medicine) Medical Superintendent

1. Administrative role of a Transfusion Medicine Specialist Dr ManishaShrivastava(M.D. Transfusion Medicine) Medical Superintendent Incharge - Transfusion Medicine and Blood Banking AIIMS Bhopal

3. Role of Doctors as Administrators Doctors in management roles can lead to improved communication between doctors and senior management (Braithwaite et al., 2005a), a Doctors are strong advocates for patient safety and quality (Degelinget al., 1999, 2001). Doctors also have greater credibility with public and peers (Simpson and Smith, 1997), and are perceived to have more power and influence compared to other health professionals (Degelinget al., 1998, 2003).

4. Blood transfusion is a complex multi-step process involving personnel from diverse background with different levels of knowledge and understanding “Why evolution is needed “ “Nothing hastens one's disappearance faster than acquiescence to predictions of extinction”  

5. Why the role needs to be played by a Transfusion Medicine Specialist ? Transfusion medicine continues to play an important role in health care, particularly in an era of managed care and reduced resources. Investment in the activities of this discipline will pay off for patients, clinicians, and hospitals. Those medical directors able to provide insight into the future of medical technology and medical care and provide true leadership and planning assistance may be an enormous asset to their facility in avoiding pitfalls, reducing costs, and paving the way for (nor just accepting) new technology that will truly facilitate care and reduce costs.

6. Role of Transfusion Expert as an Administrator Strategic role Involvement in the development of policies and standards National professional responsibilities, ability to influence quality Role in service enhancements and quality improvements Role in patient safety and patient care

7. Role of transfusion Expert as an administrator Providing adequate Blood services. Expectations for liaison with hospitals served, or other professional bodies, to provide expert advice Arrangements for cross-cover and on-call work Clinical responsibilities Specified management arrangements for the particular service, with respect to the Responsibility for supporting staff and quality assurance. Adhering to Regulatory Norms

8. Scope of Specific Roles In Administrative Capacity Donor care PUBLIC OUTREACH Setting standards for and ensuring a high level of donor care. Monitoring of effectiveness and compliance with standards. Apheresis Donors Workload statistics , donor demographics and data of blood needs.

9. Scope of specific roles in Administrative capacity Clinical Transfusion Medicine To ensure development of policies and procedures for the safe and effective use of blood. To ensure liaisoningwith clinical units to ensure that high standards of transfusion practice are achieved andmaintained. To ensure Collection of outcome data, e.g. adverse reactions to blood components. To ensure Participation in the activities of the regional and hospital transfusion committees. Hemovigilance

10. Scope of specific roles in Administrative capacity Blood components Responsibility for clinical input into development and implementation of production of new components. Involvement in clinical trials. Appraisal of hospital and government initiatives and their impact on component requirements. Monitoring the quality of components provided. Clinical advice relating to quality problems, e.g. product recall.

11. Scope of specific roles that may be included in Administrative capacity: Diagnostic reference laboratories Setting standards for laboratory service provided and ensuring these are met. Clinical reporting and, as required, advising on referred samples. Development of clinical policies relating to the investigation and support of related clinical conditions. Management of phenotyped panels and provision of cells. Provision of expert advice to referring clinicians.

12. Scope of specific roles In Administrative capacity Transfusion microbiology Input into policies/procedures for the appropriate investigation of transfusion-transmitted infections (TTIs) and monitoring and reporting of TTIs. Ensuring appropriate counselling, advice and referral for marker-positive donors and policies/procedures for handling donors with false-positive virology markers. Supervision of look-back exercises at a local level. Handling potential litigation at a local level, and national level if applicable. Responsibility or involvement in choice of non-mandatory assays and algorithms for confirmatory testing.

13. Scope of specific roles In Administrative capacity Clinical transfusion medicine Development of policies and procedures for the safe and effective use of blood. Liaison with clinical units to ensure that high standards of transfusion practice are achieved and maintained. Collection of outcome data, e.g. adverse reactions to blood components. Participation in the activities of the regional and hospital transfusion committees.

14. Hospital Transfusion Committee Hospital Transfusion Committees are multidisciplinary groups that have the overarching responsibility to maintain safe hospital transfusion practice. ( ISBT)

15. Hospital Transfusion Committee STRUCTURE HTC Chair - ideally this should be a blood user and preferably not the Consultant Haematologist in charge of blood transfusion. Secretary - HTCs should ideally have administrative support Blood Transfusion Laboratory Manager/Senior Scientists/Clinical Chemist Transfusion Practitioner Consultant Haematology in charge of blood transfusion Representatives from all clinical areas that use blood Blood supplier representative Hospital Managers Risk and Governance leads Education and Training representative Quality Manager Patient representatives

16. Patient Blood Management The appropriate use of blood and blood components, with a goal of minimizing their use.” Interactive Networking Hospital Transfusion Committee Quality Research

17. Scope of specific roles In Administrative capacity Stem cells and immunotherapy Involvement in the establishment and implementation of standards for stem cell donor selection and management. Setting standards for stem cell collection procedures and monitoring the outcome of these. Providing clinical advice to SCI laboratories. Liaison with clinical stem transplant and immunotherapy units.

18. Scope of specific roles In Administrative capacity Therapeutic apheresis Setting standards for therapeutic cytapheresis and plasma exchange, and ensuring that these are achieved. To ensure the assessment of patients and in some cases donors, e.g. those of peripheral blood stem cells. Monitoring the outcome of procedures.

19. Scope of specific roles In Administrative capacity Tissue banking Setting standards for the selection of tissue donors and ensuring that collection of tissues conforms to the highest standards of practice. Liaising with clinical users of tissue services to assure the appropriate use of tissues. Monitoring the outcome of tissue use and assisting in the reporting of adverse reactions to the useoftissues.

20. Role in Clinical effectiveness (clinical governance/audit) To participate in multidisciplinary clinical Audit Implementation of an ongoing quality improvement programme within the department. To provide advice in development of clinical guidelines, investigation protocols, laboratory SOPs and guidance on the appropriate use of tests and blood components to the clinical units supported.

21. Research and Development (R&D) Ensuring Ethical ,outcome based and innovative research opportunities to the personnel and publications from the department. Signing of MOUs to establish relationship with any local university or teaching hospital or international university , Establishing connect with or task-led funding of the institution and top heirarchy and researc related committees and bodies .

22. Teaching Versus Administration A teacher affects eternity; he can never tell where his influence stops." Administrators, on the other hand, live in the city. Although exposed to many more "citizens," they get to know very few well. The influence an administrator has on the education of children is broader -- but not as deep” . ….Henry Adams Schedules, Thesis , Examination Time and Scope

23. What we ignore or don’t see Health care trends Understand the need for collaborative relationships among different disciplines to prepare for the evolving trends in health care delivery and payment Systems awareness Aware that decisions made at any level will affect all other levels and knows how to influence these decisions. Founded in community concern, sustainable productivity, and systems thinking.

24. What we ignore or don’t see Strategic Focus Develop strategic plans that are both purposeful and visionary; remains goal oriented with a history of goal achievement, execution, and high performance. Fosters teamwork and collaboration through strong interpersonal skills Focuses on the development of high-performance teamwork among members across the organization; promotes collaboration to establish common ground, find mutual benefits, develop synergy, and create win-win situations.

26. Being a doctor , blood banker , Teacher is difficult, and administration work is challenging in its own way, but there is no reason why we should not be able to work as all towards the same goal  Administrators must never forget where they came from (and where they might return to) Arnold Peluda

27. Summary Representation of the fraternity Policy Making Time Management Communication skills Resourcefulness Strategic Planning Economics of Transfusion Medicine Knowledge of Rules and Regulation

29. THANK YOU