Introduction
Evaluating the impact of organizational change is an evidence-based process that requires the key stakeholders to assess whether the organizational intervention improved the health outcomes of patients and thus demonstrated value and effectiveness (Schrag, 2009). Clinical practice guidelines are examples of organizational change that can vary depending on the already established guidelines as well as the objectives of a healthcare facility outlined.
Overview
An example of clinical practice guideline is the World Health Organization (WHO) – World Alliance for Patient Safety guidelines, which directs and coordinates authority within the United Nations system (Joint Commission, 2012). The guideline was established for providing the leadership role on the issues of health, developing the standards and norms, laying out the policy options created from evidence, as well as monitoring and evaluating world health care trends (WHO, 2010).
The WHO patient safety guideline that was introduced into the healthcare setting is “Towards 100% voluntary blood donation: A global framework for action.” The guideline describes the process of blood transfusion as the critical service within the system of health care, and those individuals who choose to donate their blood make a tremendous contribution to patients’ survival. Since there is an ongoing global challenge to collect enough blood from safe donors, the guideline aims to provide instructions that health facilities should follow to ensure 100% voluntary blood donation, which will lead to the elimination of paid donations in the future (WHO, 2010).
Holding Professionals to the Guideline
Different professionals in the healthcare system are held to the standard of creating an environment that promotes 100% voluntary blood donation, maintains a safe and sustainable process of donations along with the donor base, and provides quality services to volunteering donors (WHO, 2010). Nevertheless, the key target audience for the guideline includes policy-makers, planners, and managers that have a direct impact on the functioning of blood donation services within healthcare facilities.
Notably, the hospital management such as the chief executive, the director of nursing, associate medical directors, general managers, and the head of services and information are held responsible for introducing the guideline into the practice setting and ensuring that all departments work towards the achievement of the 100% voluntary blood donations in the facility. With support from the National Red Cross and Red Crescent societies, the management of a healthcare facility is encouraged to hold meetings, training sessions, planning activities, and informational campaigns that promote the culture of secure 100% voluntary blood donations.
On the lower level, nurses responsible for performing blood donation procedures are required to strictly follow the rules and guidelines on safe and high-quality services as well as educate patients on the importance and the benefits of 100% voluntary blood donations within the local community. A successful blood donor program is the one that combines the efforts of the higher and the lower-standing stakeholders who can have their influence on different levels of the healthcare organization’s performance. The dissemination of knowledge and information among departments is successfully conducted through seminars and workshops that provide valuable opportunities for facilitators and participants who share insights and experiences contributing to the success of the blood donor program (WHO, 2010).
Research for Adopting the Guideline
The research used for adopting the guideline heavily relied on the national and global statistics of blood donations. According to the American Red Cross (2017), in the United States, someone needs blood every two seconds, with around thirty-six thousand units of red blood cells needed every day. Furthermore, as cancer is one of the greatest challenges for modern health care, patients need blood (in some cases even daily) in the course of their chemotherapy treatment (American Red Cross, 2017).
The process of research is a vital tool targeted at understanding current and potential donors. Conveniently, research is neither complex nor costly; however, it requires a systematic approach. The first step is assessing the data gathered from already available records. For instance, a high discard rate usually implies that the materials targeted at educating doors are insufficient and that donor selection criteria are unclear (WHO, 2010). Research studies regarding the psychology of blood donation (Masser, White, Hyde, & Terry, 2008) and blood donor incentives (Abolghasemi, Hosseini-Divkalayi, & Seighali, 2010) are useful sources for getting insights and ideas for the guideline implementation. Apart from local research institutions, it is also important to include global research data that could be relevant in a variety of contexts.
Evidence for Defining the Guideline
Evidence used to define the guideline is related to the context of the emergency and non-emergency blood transfusions that are often key to saving the lives of patients. Field experiments have presented sufficient evidence suggesting that 100% voluntary blood donations are crucial for improving the quality of patient care and eliminating the challenges that currently exist within the clinical setting. For instance, the field experiment conducted by Goette and Stutzer (2008) showed concern that material incentives for blood donation have an undermining effect on prosocial motivation, which subsequently leads to the decrease in blood donations rather than their increase.
Therefore, the WHO (2010) guideline promotes voluntary blood donations since they positively influence prosocial motivation and contribute to society. Evidence of prosocial behavior and motivation is highly relevant in the context of 100% voluntary blood donations since the WHO (2010) guideline for patient safety is not targeted at manipulating donors’ visibility of such behavior but rather educating them on the importance of donations and providing them with relevant evidence suggesting that voluntary donation of blood could elevate the challenges many healthcare facilities face when it comes to the supply of blood. Moreover, Goette and Stutzer (2008) mentioned that monetary incentives for blood donation present risks for the safety of donors and increase the likelihood of infections.
Demographic data is another type of evidence used to define the patient safety guideline for 100% voluntary blood donations. According to the research conducted by Shaz, James, Hillyer, Schreiber, & Hillyer (2011), 98.7% of all donations come from individuals aged between 16 and 69 years, 77.7% of whom are white, 16.3% are African-American, 2.3% are Hispanic, 2.2% are Asian, and 1.6% are other donors. Moreover, donors aged between 40 and 49 donated the highest percentage of units. Demographic evidence can show the peculiarities of the local population and determine whether there is a need for placing a focus on the representatives of a particular demographic group; however, the 100% voluntary donations guideline invites as many different donors as possible.
Levels of Evidence
If to discuss the level of evidence used in the evidence-based practice quality improvement guideline, it is important to first mention that any evidence is relevant for the 100% voluntary blood donations program, ranging from evidence from authorities’ opinions to evidence from systematic reviews of a meta-analysis of the relevant randomized controlled trials (Winona State University, 2017). However, the most relevant and reliable evidence for the development of the WHO guideline was acquired from level I – level III, which included evidence from systematic reviews, well-designed randomized control trials, and controlled trials without randomization. These three levels of evidence provided enough relevant information for developing the guideline and ensuring that the interests of donors are maintained throughout the process of the program implementation.
As mentioned previously, key evidence regarding the importance of 100% voluntary donations was associated with gathering data as to the ineffectiveness of incentivized blood donations and the lack of prosocial motivation among the public. A large well-designed randomized control trial conducted by Goette and Stutzer (2008) provided an extensive background for the development of the voluntary blood donation guideline that was not associated with any kind of incentives and only promoted free donations that community members chose to undergo voluntarily.
How Professionals Followed the Guideline
While it is challenging to determine how well the guideline is followed by all professionals, it can be asserted that the 100% voluntary blood donations quality improvement program has become an effective tool for encouraging all stakeholders involved in the process to educate potential donors and establish an environment that will facilitate voluntary donations.
First, healthcare professionals were required to meet the guideline for safe blood donations with the help of strengthening the donor program. Even the most well-designed and well-integrated quality improvement program requires constant control and extensive work for bringing in new donors while maintaining close relationships with the already existing ones.
The chief executive of the healthcare facility, the director of nursing, associate medical directors, general managers, and the head of services and information all work cooperatively to comply with the patient safety guideline and promote the environment that will encourage donors to donate blood and educate them on its importance. It is crucial to mention that all healthcare professionals coordinate their resources to develop a cohesive program that in the future will achieve a safe and sufficient blood supply (WHO, 2010).
The healthcare professionals involved in the guideline follow the following action points for expanding and strengthening the 100% voluntary blood donation program:
- Assessment of the healthcare facility’s information needs and provision of current and relevant data and evidence targeted at illustrating the case for supporting the implementation of the guideline.
- Identification and collaboration with key stakeholders that have the ability to provide internal advocacy for the needs of blood donors within the healthcare organization.
If to provide an opinion on how well the professionals followed the guideline, prominent efforts were seen on the part of head of services and head of information that were engaged in the promotion of the 100% voluntary blood donations, involvement of possible donors into the conversation about the importance of blood donations for the patients in need.
It is also important to distinguish the work conducted by the director of nursing who invested time and efforts into educating nurses on how they should communicate with donors, what procedures should be followed during the process itself, which specific emergency measures should be undertaken if the situation calls for it, as well as what information should be collected for ensuring the success of the program. The chief executive of the healthcare facility was responsible for the assessment of the guideline’s implementation and identification of challenges and barriers that prevented the healthcare facility’s team from fulfilling its tasks.
Despite the fact that the adherence to the program was limited by the lack of cooperation between professionals, each stakeholder was assigned a specific role, which was followed to the best possible extent. Professionals within the system saw the 100% voluntary blood donations as a step forward to providing high-quality care and closing the gap with regards to the lack of available blood units for covering emergency situations (e.g. a patient surviving a severe car crash) and regular treatment (e.g. blood transfusions to patients undergoing chemotherapy for battling cancer). For this reason, professionals that operated within the health care environment were all focused on educating the already existing donors and potential donors on the importance and the effectiveness of the 100% voluntary blood donations for the well-being of the local community. Although some processes could have been performed better, the overall contributions of all stakeholders can be regarded as positive.
Discussion
The vision of the quality improvement program was the achievement of 100% voluntary blood donation in as many healthcare facilities around the globe as possible (WHO, 2010). The provision of the sustainable blood supply provided by non-remunerated blood donors is key to reducing the gaps that are associated with the lack of donor blood units in healthcare facilities that do not have sufficient practice guidelines that dictate the implementation of such quality improvement programs. Although the goal of reaching 100% voluntary blood supply in all healthcare facilities is rather ambitious, it is worthwhile since it could elevate the level of prosocial motivation and responsibility within local communities.
Cooperative work of the main stakeholders involved in the process of planning, training, and program implementation was crucial for reaching the established goals. In conclusion, it can be stated that the guideline helped the healthcare facility to establish a well-organized blood transfusion service coordinated on both local and national levels, providing and maintaining sufficient blood supplies when needed (WHO, 2010). The program provided rationale for collecting blood from voluntary non-remunerated donors and the subsequent phasing out of paid and replacement blood donations.
Quality testings were also in place (e.g. screening for possible transfusion infections) for ensuring the high quality of services and the reduction of unnecessary transfusions that exasperate donors’ and patients’ risks of getting infected. Lastly, the quality improvement program was successful with the help of the effective quality systems implementation, quality management, the development of standards for quality, a cohesive system of documentation, and staff training (WHO, 2010).
Lack of funding could be a significant limitation for the development and the implementation of the 100% voluntary blood donor quality improvement program; however, engaging large healthcare organizations that monitor the sufficiency of quality improvement programs can effectively eliminate this barrier. Overall, the 100% voluntary blood donations initiative is an important step towards providing patients with high quality of care and ensuring a sustainable supply of blood units that can be used for different clinical treatment purposes. By engaging the community into being proactive in their social position, healthcare facilities around the world can contribute to the elimination of issues associated with the supply of donor blood.
References
Abolghasemi, H., Hosseini-Divkalayi, N., & Seighali, F. (2010). Blood donor incentives: A step forward or backward. Asian Journal of Transfusion Science, 4(1), 9-13.
American Red Cross. (2017). Facts about blood needs.
Goette, L., & Stutzer, A. (2008). Blood donations and incentives: Evidence from a field experiment.
Joint Commission. (2012). Examples of clinical practice guidelines or practice standards developed by organizations or professional societies regarding aspects of CLABSI prevention or diagnosis.
Masser, B., White, K., Hyde, M., & Terry, D. (2008). The psychology of blood donation: Current research and future directions. Transfusion Medicine Reviews, 22(3), 215-233.
Schrag, D. (2009). Evaluating the impact of organizational changes in health care delivery: Challenges in study design. Journal of Clinical Oncology, 27(11), 1744-1745.
Shaz, B., James, A., Hillyer, K., Schreiber, G., & Hillyer, C. (2011). Demographic patterns of blood donors and donations in a large metropolitan area. Journal of the National Medical Association, 103, 351-357.
WHO. (2010). Towards 100% voluntary blood donation: A global framework for action. Web.
Winona State University. (2017). Evidence based practice toolkit.