Delivering Value. Annual Report

Transcription

1 Canadian Blood Services Annual Report Delivering Value Annual Report Canadian Blood Services 1800 Alta Vista Drive, Ottawa, Ontario k1g 4j5 Tel: donate ( ) blood.ca

2 About Canadian Blood Services Canadian Blood Services manages the national supply of blood, blood products and stem cells, and related services for all the provinces and territories (excluding Quebec). We also lead an integrated, interprovincial system for organ donation and transplantation for all of Canada. We are dedicated to improving patient outcomes through the manufacturing and delivery of safe, relevant, quality products and services to Canadians. Generous donors, volunteers, corporate partners and employees make this possible. We are grateful for their ongoing commitment to helping save or improve the lives of many Canadians. Canadian Blood Services operates an integrated, pan-canadian service delivery model. Our national scope, infrastructure and governance make us unique in the Canadian health-care landscape. Canadian Blood Services was founded in 1998, based on recommendations from the Krever Report on the tainted blood scandal. We are regulated as a biologics manufacturer by Health Canada and primarily funded by the provincial and territorial ministries of health. Canadian Blood Services is a not-for-profit charitable organization. On the cover Deborah Hunte is a blood recipient and volunteer for Canadian Blood Services. She has sickle cell disease, a genetic blood disorder requiring medical treatments as well as blood transfusions to control the pain. Unfortunately, Deborah lost her sister, Sandra, and brother, Geoffrey, to the same disease. As a member of Canadian Blood Services volunteer speakers bureau, she shares her story with different organizations, hoping to inspire others to become involved. It s her way of showing gratitude to blood donors, not just for prolonging her life but the lives of her sister and brother. Table of Contents 24 A message from our chair and our chief executive officer 28 Management discussion and analysis 46 Management s report to members 47 Independent auditors report 48 Financial statements and notes This broad understanding of our role in delivering value frames the following annual report, which covers the fiscal year from April 1, 2013, through March 31, Canadian Blood Services acknowledges the funding of provincial and territorial governments in the delivery of its programs. The views expressed in this document are those of Canadian Blood Services and do not necessarily reflect those of the provincial and territorial governments. Creative Development and Design: Soapbox IIllustration: Doug Ross Photography: Lorella Zanetti Content Development and Writing: Doug Dolan

3 The idea of value in health care goes far beyond dollars and cents. At Canadian Blood Services, we share the fundamental goals championed by our partners in health-care systems across the country: to ensure the best possible delivery of care and constantly improve patient outcomes while optimizing cost-efficiency. Better care Better outcomes Optimal costs Delivering value By embracing the same priorities as our partners, we ensure that the diverse initiatives we pursue are all directed at one ultimate goal: delivering value to Canadians. As prudent stewards of financial assets, we must carefully manage every dollar in our budget. But this is only one facet of our broader commitment to product safety and effectiveness, reliability of supply and the sharing of best practices, innovative research and proven models of service delivery. Together, these diverse elements constitute Canadian Blood Services primary values of delivering quality care, enabling better patient outcomes and judiciously managing costs. Canadian Blood Services Annual Report

4 In a climate of fiscal restraint, our strategy is clearer than ever. There are two equally important dimensions to what we deliver as a pan- Canadian organization. We manufacture safe, effective biological products designed to meet patients needs in the right place at the right time. Equally important, we provide clinical services in areas such as organ donation, stem cell matching and laboratory diagnostics that help advance patient care beyond the traditional realm of blood and related products. The heart of our strategy Manufacturing biological products Including red blood cells, platelets, plasma and stem cells (from bone marrow, blood and cord blood) Providing clinical services Including registries, medical services, knowledge, tools and expertise Recruitment Identifying and attracting potential donors for all products, from blood to stem cells, as the first step in the supply chain Supply Chain Management Planning, collection, manufacturing, testing and distribution of biologics products to the right place at the right time Clinical and Medical Services From registry management to diagnostic services to guidance on product utilization Innovation Research; knowledge creation, application and exchange; education; and new product development Everything we deliver as both a biologics manufacturer and a clinical services provider is focused on two key objectives: 1 products 2 Continually Improving patient outcomes through the manufacturing and delivery of safe, relevant, quality and services to Canadians. earning the right to serve through our commitment to safety, performance improvement, and responsible and accountable financial management. Created by and for Canadians The public must have access to information about the policy, management and operations of the blood supply system and be represented in decision-making. Justice Horace Krever At Canadian Blood Services, every strategic decision is aimed at advancing the health and well-being of the people we re empowered to serve. Our organization was created following four years of intensive public consultation by a federal commission of inquiry headed by Justice Horace Krever that heard nearly 500 submissions and reviewed more than a million pages of evidence. The Krever Commission s final report, tabled in November 1997, established the mandate for a pan-canadian system under a single operator, with sufficient funding, clear accountability and a commitment to making public safety paramount in every operational, technical and clinical area. We remain focused on those founding principles as an organization created by and for Canadians. 2 Canadian Blood Services Annual Report

5 I tell people who have never donated that the time is now to help because you never know when it could be you needing blood. Brent Cairns Donor, peer recruiter

6 We ve reorganized how we work to better implement our strategy. Integrated supply chain management now shapes every area of our operations as a biologics manufacturer. At the same time, we ve brought our clinical services more closely together, guided by a common strategic direction. Riley Knowles, volunteer Two years ago we undertook a systematic review of our priorities as an organization, which ultimately yielded a refreshed corporate strategy. This, in turn, led us to rethink how we could best put our updated strategy into action and support day-to-day operations. As a key initial step, we introduced a new organizational structure at the end of last year. Implementing that structure has been a challenging and sometimes disruptive process, but with each incremental change we ve stayed focused on one goal: the execution of our long-term strategy. To better meet our stakeholders needs as a manufacturer of biological products, we ve adopted a more integrated operating model. Lines of business that for historical reasons were separately managed have been brought together, ensuring our efforts are better coordinated from initial donation through to the delivery of products on the front lines of health care. Similarly, in our role as a clinical services provider, we ve found better ways of organizing ourselves to take advantage of our collective expertise in everything from the management of transplant registries to the sharing of knowledge through professional education. 10% Reduction in administrative FTEs The primary reason for the organizational redesign implemented over the past year was to ensure that Canadian Blood Services is ideally positioned to execute our long-term strategy. However, because our redefined strategic priorities are focused on helping us deliver our products, services and programs more effectively, their implementation has also enabled us to do so with less administrative support. By simplifying organizational layers and finding ways to work more productively, we will reduce our total number of full-time-equivalent (FTE) positions in administrative functions by more than 10 per cent. 4 Canadian Blood Services Annual Report

7 From the donor clinic to the patient s bedside, every step counts. We re constantly re-examining each critical step in the supply chain to improve quality control, eliminate redundancy and waste, and automate processes for greater precision all while making the system safer and more effective and efficient than ever. Nancy MacNeil, employee Over the past year we moved to a more integrated model of supply chain management, changing how we re organized to facilitate the flow of products and information. As a result, we re able to more effectively plan and manage all of our activities as a biologics manufacturer, from donor clinic operations and the sourcing of medical supplies, through production and testing, to the timely delivery of safe, high-quality products to patients in need. At each key step in the process, meaningful real-time data and metrics will now be visible to everyone on the team, helping us make better-informed decisions. Previously, Canadian Blood Services was organized into lines of business that delivered specific products and services. While this structure helped us focus on developing unique systems and processes in each business line, it was difficult to identify potential areas of collaboration and take advantage of common skillsets. For example, the two groups testing stem cells and fresh blood components used comparable equipment and expertise but operated independently of one another. In our redesigned organization, all products are aligned in a single supply chain. There are differences in systems but also common standards for operating them. Similarly, the specifics of accreditation may vary for employees, but there are many opportunities for productive collaboration. From a management perspective, there are similar practices in everything from quality assurance to maintenance that make it simpler and more efficient to oversee all operations from one vantage point. Canadian Blood Services Annual Report

8 Logical integration Supply chain integration has not only erased the boundaries between products but also streamlined sequential process steps. For example, logistics is no longer a support service managed at the corporate level; it is now embedded in our supply chain processes, making it far easier to plan ahead, manage day-to-day operations and maximize resources as efficiently as possible. Integration also opens up new opportunities for productive innovation. For example, in taking a more holistic approach to the first step in our supply chain, donor recruitment, we envision building a dialogue with donors through which we can better align their generosity with current patient needs. By communicating transparently about the demand for certain blood types, optimal donation times and other factors, we can maintain an ideal balance between building positive relationships with donors and ensuring we derive the greatest possible value from their vital contributions. The change in approach has also encouraged us to be more innovative and targeted in our talent recruitment. Most importantly, we ve made huge strides in our ability to plan for the future. With a comprehensive vision of our entire supply chain, we can review detailed performance analytics and will now be able to produce more accurate forecasts to better manage capacity, workflow and the allocation of resources. If any factors affecting supply and demand change, we can model potential scenarios and find the best solution to keep our operations running safely and smoothly. Improving our blood information system Each unit of blood collected at a donor clinic is entered into an information system that tracks its progress through testing, manufacturing, distribution and final delivery to a hospital. This process ensures it will be fully traceable at each safety and quality control step along the way. In 2013, we introduced eprogesa, our updated blood management information system. Working closely with the developer, we added more robust tracking and reporting capabilities, as well as a more user-friendly interface, to bring even greater transparency and precision to how we manage blood products. Rather than roll out the upgrade in phases, we knew it would be less disruptive to switch over to the new system in a single transition. To prepare for the change, nearly 3,500 employees were trained on the new system and more than 125 standing operating procedures were updated. When the formal cutover came in February 2014, it was the culmination of a multi-year planning process; as a result, there were no significant issues during the 36-hour implementation, and all measures taken to maintain a safe, secure blood supply were performed smoothly. The upgraded information system has brought a new level of sophistication to our management of blood collection and distribution. With instant access to tracking data and the ability to add medical information and adjust inventory in real time, we gain valuable additional tools in our ongoing efforts to optimize the supply chain. Moreover, the system s web-based technology will make it easier to integrate future enhancements, both to our operating processes and to the experience of donors and hospital partners. 6 Canadian Blood Services Annual Report

9 Automating processes The next step in the evolution of our supply chain management will be to introduce more automation to further enhance safety and productivity. Our current paper-based system is complex and susceptible to errors. Over the past year we ve built the business case for automating our collection processes so that data can be captured when it is received by the clinic or at each subsequent process step. This automation strategy includes a self-administered electronic questionnaire that donors can complete at the clinic or for added convenience fill out online prior to their arrival. Through all stages of the donation process, clinic staff will be able to enter information directly into the system. Monitoring hospital usage This year we significantly enhanced the system that enables us to monitor and evaluate hospitals use of Canadian Blood Services products. Implemented in May 2014, the new solution allows administrators to report on the disposition of fresh blood components and plasma products using a web-based application. Data is compiled monthly to generate detailed reports, providing a clearer picture of how products are used and supporting more accurate comparisons among peer hospitals. The system also generates daily inventory reports. 98% Satisfaction This year our performance in delivering blood products yielded a 98% satisfaction rating from large hospitals across Canada that use 3,000 or more units of red blood cells annually. This was a significant increase from our score of 88% in the previous year, when temporary service challenges arose as we shifted production and distribution functions from several Ontario locations to our new facility in Brampton. Adding new production and distribution facilities In March 2013, we moved our Halifax production and distribution functions to a new facility in Dartmouth, Nova Scotia (photo), and shifted collection and logistics for southwestern Ontario to a new location in London. With the addition of a donor testing lab at the Canadian Blood Services site in Brampton, Ontario for which we received approval in the spring of 2014 we will complete Phase I of our multi-year National Facilities Redevelopment Program. Phase II is focused on Alberta and Saskatchewan; a business case approved by our board of directors has been submitted to governments, who are consulting with us on funding and financing options. Canadian Blood Services Annual Report

10 Being on the National Liaison Committee really opened my eyes to how critical the blood supply is to so many user groups. Dennis Koebel Blood donor, volunteer 8 Canadian Blood Services Annual Report

11 We treat every product as if lives depend on it because they do. Canadians trust us not only to collect and distribute blood and stem cells but also to get the right products to the right patients at the right time at the right cost while upholding the highest standards of safety. Jeanette Posey, volunteer There has been a slight yet steady decline in Canadian demand for blood products as health-care systems adopt more efficient approaches to utilization, and blood conservation and surgical techniques. In this context, it is vital that we continue to reduce the average number of labour hours required per unit, even as we lower collection targets, while always maintaining our rigorous quality controls. At the same time, we must keep pace with emerging expectations about how blood products are selected and deployed for example, the increased demand from hospitals for platelets that have undergone HLA (human leukocyte antigen) typing. There are also potential donor health concerns, such as a decrease in iron levels that may require lengthening the time between donations for young female donors, among others. The diminishing need for many fresh blood components is in contrast to the growing demand for specialized plasma products. We have seen an average annual increase of 6.5 per cent in use of the latter over the past several years, despite new utilization measures introduced by some provincial health ministries. Of particular concern is the growing off-label use of these expensive products, sometimes in the absence of compelling medical evidence that they support effective treatment. The resulting pressure on our traditional sources of supply has obliged us to begin evaluating alternatives. Canadian Blood Services Annual Report

12 National Public Cord Blood Bank Over the past year Canadian Blood Services continued to spearhead the development of Canada s national public cord blood bank. The first collection site for umbilical cords a rich source of stem cells for the 70 per cent of transplant patients who must find matches outside their families was launched at The Ottawa Hospital in September 2013, at the same time as the bank s first manufacturing and storage facility began operating in the city. A second production and storage facility is scheduled to open in Edmonton in the fall of 2014, and additional collection sites in Brampton, Edmonton and Vancouver will begin operations over the coming year. Meanwhile, we continue to focus on our capital campaign for the cord blood bank. We have undertaken to raise $12.5 million as part of the total combined commitment of $48 million from the provincial and territorial ministries of health (except Quebec). The Campaign For All Canadians, the first fundraising effort ever undertaken by Canadian Blood Services, has raised $8.4 million in cash and signed pledges as this report goes to press. With the campaign now in its public phase, we expect to meet the balance of our commitment by the end of December $65M saving In recent years, Canadian Blood Services has negotiated new contracts with suppliers of immunoglobulins, recombinant factor VIII (a bloodclotting protein used to treat hemophilia) and other plasma products to secure the best possible pricing and terms. Compared to the previous year, these agreements helped save $65 million this year in plasma product costs a testament to the value of our buying power on behalf of the provinces and territories. The peak of commitment In August 2013, a team led by Canadian Blood Services CEO Dr. Graham Sher climbed Africa s Mount Kilimanjaro to support the Campaign For All Canadians, which was launched to fund a national public cord blood bank. All 25 climbers reached the summit (photo), generating wide interest via social media and raising more than $350,000 plus an additional $115,000 in sponsorships. $12.5M Canadian Blood Services has committed to raising $12.5 million in support of Canada s national public cord blood bank. The bank will be a vital resource for all Canadians in need of stem cell transplants, especially for Aboriginal Canadians and people of mixed ethnicity, who face more difficulty in finding donor matches. 879,940 whole blood units This year we collected 879,940 units of whole blood from a national pool of just over 412,000 active donors who average slightly more than two donations annually Project Recovery In a world first, the Canadian Hemophilia Society has enlisted the support of Canadian Blood Services and two other manufacturers to turn unused blood products into hemophilia medicine for developing countries. Officially launched in September 2013, Project Recovery will take previously discarded cryoprecipitate from Canadian blood donations and use it to produce factor VIII, a protein necessary for blood coagulation. Distributed through a humanitarian aid program overseen by the World Federation of Hemophilia, the product will go to patients who receive little or no medical treatment and would otherwise be at risk of death or severe disability. The project is expected to yield enough units of factor VIII each year to treat approximately 5,000 joint hemorrhages, the most common symptom of hemophilia, in both children and adults, sparing them excruciating pain and crippling long-term damage. 10 Canadian Blood Services Annual Report

13 For us, quality is more than protection; it s about adding value. Our quality journey remains focused on maintaining the highest standards of product safety and effectiveness, and reliability of supply. At the same time, we offer expert guidance to help our partners achieve better patient outcomes. Ellen Flores-Abad, employee Our perspective on quality is outward-looking. Internally, all of our processes are focused on consistently delivering safe, tested and effective products and services. The true value of those efforts, however, can only be measured by their success in meeting the needs of patients. The quality of a donated blood unit, or the efficacy of a match in one of our transplant registries, is ultimately determined by whether it has the intended effect on the person who needs it most. At the same time, our quality journey is framed by another key insight: We re in business to provide not only the products and services we develop but also our expertise on how they can achieve the most positive impact. Our medical specialists provide guidance to clinicians on what fresh blood component is best for treating a specific condition or how our organ registry data can help to shape a transplant strategy. On a broader level, we regularly share research with health-care administrators on new products in development and the improvements we ve made to our own processes. We re constantly enhancing and augmenting the tools we provide to hospital blood banks to encourage more effective product utilization. For example, we ve improved our web-based disposition reporting system for all fresh blood components and plasma products. And we ve introduced an inventory management reporting system that will facilitate the development of an accessible and automatically updated national inventory. We re also working with governments and other stakeholders to improve the tracking of factor concentrates issued for home-care use, with the goal of better understanding and improving utilization of these products as well. Our overall goal is to seek more areas where our knowledge and experience can add value. It s one more dimension of our role as a proactive partner in health care, working alongside other leaders toward common quality goals. Canadian Blood Services Annual Report

14 Anatomy of a recall Paying for plasma In August 2013 Canadian Blood Services issued a recall notice to hospitals regarding 1,500 units of blood for which one of our standard tests for Cytomegalovirus (CMV) was not performed according to specifications for a period of three days. CMV is a common community-acquired infection that lies dormant in white blood cells and is harmless for most people. CMV-negative blood is required only by a few patients with special needs, such as low-birth-weight infants and people with compromised immune systems. Therefore this was a recall addressing a remote risk. That said, any recall is clearly unwelcome for an organization committed to ensuring the safety and reliability of Canada s blood supply. To minimize the likelihood of any nonconformance with established standards, we must ensure that the rigorous policies and procedures we ve put in place are always followed. And in the rare event that a process is not properly executed, it s essential that we have systems for rapidly detecting the lapse, along with appropriate steps for recalling, if necessary, any potentially compromised products. Importantly, in this case the fact that a shortcoming in CMV testing was discovered in a routine audit confirms that our exacting safety standards are indeed being applied. And our management of the response and subsequent recall demonstrates our adherence to sound quality principles though of course we d prefer that this event had never occurred in the first place. The debate over paid plasma donations continued to generate public discussion over the past year, notably when the Ontario provincial government introduced legislation that would effectively prohibit organizations from paying all blood donors, including plasma donors. Our position on this issue remains clear: The question of whether to allow payments to plasma donors is a moral and ethical decision for policy-makers to arrive at through consultation and debate with Canadians. It is not about safety. Decades of evidence have proven that pharmaceutical products made from the plasma of paid donors are just as safe as those made from the plasma of volunteer donors. Although Canadian Blood Services is exempt from the above prohibition, we remain committed to voluntary donation and have no intention of paying donors. 82% Trust rating In our annual survey of Canadians trust in the blood system we scored two points higher than our 80% target for Canadian Blood Services Annual Report

15 Having had several family members receive blood, myself included, the best part of my job is inspiring others to donate and save someone else s life. Melissa Smith-McGuire Blood recipient, employee Canadian Blood Services Annual Report

16 We re building deeper, long-term relationships with donors. To strengthen the vital human element in our supply chain, we re encouraging dialogue with donors in various ways, guiding them toward other donation options and keeping them engaged through the unfolding stages of their lives. Tyler Dorey, employee. Dave Thomson, volunteer We ve made donor relations a distinct area of focus in our redesigned organization. In taking a fresh look at our interactions with donors, we re shifting our focus from how we can fulfill our own operational needs to how donors view us, as well as the role they can play in improving other people s health and the overall quality of care. This is an important step for Canadian Blood Services as we recognize the growing demands being placed on donors in all areas of their lives. We must evolve our donor relations to remain relevant to Canadians and remind them that blood donation is a rewarding way they can contribute to their communities. To get to know our donors better, we re adopting a life-cycle management approach. By focusing on the progressive stages of donors relationships with us awareness of need, first donation, repeat donations and, ultimately, advocacy to family and friends we can find more opportunities to build dialogue and reinforce their support. At the same time, we can broaden their understanding of other areas where they might consider contributing. For example, someone who regularly gives blood may be interested in also registering as a potential stem cell or organ donor; a female donor who becomes pregnant may be willing to donate her umbilical cord to the national cord blood bank; and so on. Our new donor relations focus has three key components: audience, communications and technology. For our core audience of potential donors, Canadian Blood Services draws from a robust and loyal base. Historically, however, our knowledge of donors has largely been limited to the specific interactions they ve had with us. The result has been a fragmented view of our most committed audience as we ve connected with them at blood clinics and via the stem cell registries up to a dozen interactions in all. Now we re seeking donors help in gaining a more complete picture of who they are. This includes not only demographic information but also the nuances of their diversity, as well as the attitudes behind their support for Canadian Blood Services and comparable organizations with social purpose. 14 Canadian Blood Services Annual Report

17 The donor life cycle Awareness of need 2. First blood donation 3. Regular blood donor 4. Advocacy to others 5. Support in other areas (registries, cord blood, fundraising, research) 2 Giving on the move To ensure donors can connect with us in all the ways they prefer to communicate, this year we invested in the development of our first mobile app, GiveBlood, which was officially launched in the spring of Donors can use it to search for nearby clinics, book appointments, review eligibility criteria, set reminders and chat with the donor support team anywhere they travel with their smartphones. Available in English and French for both Apple ios and Android devices, GiveBlood has been embraced by donors; as this report goes to press, it is the top-ranked health-related app in Canada. The next release will include more social media features. At the same time, work on the redesigned Canadian Blood Services website, which began in this reporting year with a launch date targeted for later in 2014, has taken into account the needs of mobile users. Getting to know our donors better is a two-way street that requires a coordinated approach to communications. We plan to deliver more timely updates on all aspects of what we do, from transplantation registries to epidemiological studies to the national public cord blood bank. We also need to provide clear, accessible answers to donors questions about everything from priority blood types and hospitals changing needs to eligibility criteria and what to expect at a clinic. In the age of digital communications, people want immediate access to information so they can make better decisions. And by sharing the reasons behind our decision-making for instance, why a surplus of AB-positive blood might lead us to suggest that such donors consider plasma donations instead we can build the kind of open and collaborative relationships that retain donors. As donors embrace new technologies, they expect to interact with us via multiple channels. Last year we had 7.5 million telephone conversations with existing and potential donors; we opened a second National Contact Centre in Saint John, New Brunswick, to provide additional support in handling the high volume of inbound and outbound calls. At the same time, donors booked nearly 100,000 clinic visits through our online appointment system. Going forward, we ll be putting even more emphasis on digital communications beginning with our new mobile app (see sidebar) as we offer donors the fast, convenient connectivity they ve come to expect in all areas of their lives. By engaging with them via Facebook, Twitter and other social media, as well as the interactive areas of our enhanced website, we ll gain insights into how we can better respond to their interests and build a dynamic community, particularly among the Millennials who represent our future donor base. Canadian Blood Services Annual Report

18 I feel very blessed to have had the opportunity to save someone s life. If it happened again, I d be the happiest person. Kabir Chughtai Blood and stem cell donor 16 Canadian Blood Services Annual Report

19 Counting on donors 4.6 million Estimated potential Canadian donor pool, based on eligibility criteria for our products and services, as well as a predisposition to be engaged in the community. 412,000 Current pool of active Canadian Blood Services donors and registrants our primary focus for deepening engagement and suggesting new ways they can contribute. 450,000 Short-term target for growing the pool of active donors. This goal takes into account several factors, including an overall decline in demand for blood products against the rising use of specialized plasma products, the emergence of new pathogens around the globe and the impact of lower iron levels (and therefore reduced donation frequency) among some donors. 150,000 Approximate number of donors who were deferred last year because they did not meet the eligibility criteria for donation. We appreciate their desire to give and are working to suggest other ways they can stay involved. Canadian Blood Services Annual Report

20 We create vital connections that improve health and save lives. From our management of the Canadian Transplant Registry and its related interprovincial programs the Kidney Paired Donation program, the National Organ Waitlist and the Highly Sensitized Patient program to the best practices we ve developed in delivering services across the country, we draw upon a wealth of experience as we collaborate with Canada s health leaders to help patients get the care they urgently need. Heather MacDonald, employee and blood donor, and daughter Alexis MacDonald, blood recipient Canada has a lower organ donation rate (relative to population) than other developed countries, and demand continues to exceed supply. While there has been some improvement since 2008, when the mandate of Canadian Blood Services was extended to include organ and tissue donation and transplantation (OTDT), the pace of progress has been modest. As we noted in responding to the 2013 annual report of the Canadian Organ Replacement Register (CORR), that pace could be accelerated if provincial governments adopt a cost-shared, nationally coordinated approach to tackling the challenge. Canadian Blood Services is well positioned to facilitate the process, but for the system to improve there must also be continued investment in both front-line provincial services and interprovincial collaboration. One important sign of progress has been an expansion of deceased donations, as programs have been able to acquire more organs after cardiac death. Working in this area with the critical care community and provincial organ donation organizations, Canadian Blood Services has supported knowledge translation by arranging for national and international experts to participate in programs aimed at enhancing performance at the front lines of patient care. We ve also developed leading practices with some of the world s most respected practitioners and in the process have advanced our own expertise as we create workshops in which teams from successful programs engage with and provide mentoring to their counterparts in the interprovincial programs. Our evidence-based recommendations have triggered changes in program delivery that lead to higher donation rates and more transplants. We have also consulted extensively on the proposed design of a national donation and transplantation system, as detailed in our 2011 Call to Action report. Since the report was tabled with governments, its recommendations on organ donation and transplantation have been implemented to varying degrees across the country. Our 18 Canadian Blood Services Annual Report

21 Stem cell stats 339,558 Total number of searchable stem cell registrants at the end of March 2014 an increase of 9.8% over the previous fiscal year. 333 Stem cell transplants from unrelated donors performed in Canada (excluding Quebec) during the last fiscal year. 39% 40% Total male and female registrants under age 36 up four percentage points, reflecting our targeted recruitment of younger donors. 7% Segment of ethnic males under age 36 a gain of one percentage point, but evidence that there is still work to be done in aligning the registry with the 30% of Canada s population who are aboriginal, 21% Increase in Canadian donations for international patients over the past year, reflecting our close cooperation with the operators of more than 70 other stem cell registries globally. 1,000 Approximate number of Canadians currently on waiting lists for suitable unrelated donors. The total number of patients seeking life-saving Proportion of male registrants, from ethnically diverse stem cell matches has tripled of whom 16% are under age backgrounds or of mixed over the last five years, making 36. The latter group represents ethnicity. the national public cord blood optimal donors, as stem cell bank more needed than ever. transplants from young men result in fewer complications and better patient outcomes. collective efforts are now focused on creating the report s recommended clinical governance structure among the provinces, including guidelines on how provincial systems that collaborate on programs will be accountable to one another. This work is critical to ensuring the next level of success. In the area of tissue donation and transplantation, a unified pan-canadian strategy remains elusive. Demand for many types of specialized tissue continues to be met largely by products imported from the U.S. Across Canada, eye and tissue programs still operate essentially with a provincial focus; tissue production and distribution among the provinces have yet to be integrated. In the meantime, in the absence of a unified strategy, Canadian Blood Services plays a key role by advancing the development of leading practices in tissue banking, professional education to encourage tissue donation, public awareness initiatives and the collection of national data. Demand for stem cell transplants continued to grow last year, albeit at a slightly slower rate, as research continues to reveal promising new treatment uses. The OneMatch Stem Cell and Marrow Network, the national registry developed and managed by Canadian Blood Services, had nearly 340,000 adult donors at the end of March 2014, an increase of 9.8 per cent over the previous year. This strong growth reflects the success of our recruiting efforts to improve the demographic composition of the registry. The increase also mirrors the expansion of potential uses for stem cells to include treatment of Type 1 diabetes, rheumatoid arthritis, congenital heart disease and cerebral palsy adding to a list of more than 50 other diseases and disorders, from leukemia to aplastic anemia. Meanwhile, cord blood banks worldwide are challenged by inventories of lower-quality umbilical cords with minimal donor diversity a cautionary trend as we work to establish Canada s national public cord blood bank. Canadian Blood Services Annual Report

22 Interprovincial programs and the Canadian Transplant Registry In 2008, Canada s federal, provincial and territorial governments (except Quebec) recognized the need for improvements to the country s organ and tissue donation and transplantation (OTDT) system. Together, they gave Canadian Blood Services a mandate to conduct activities related to: Developing a strategic plan, including mandate, roles and responsibilities in a nationally coordinated system. Leading practices; professional education and knowledge translation; and public education. System performance improvement, including systemwide reporting. Three interprovincial patient registries for organ transplantation: the Living Donor Paired Exchange (LDPE), the National Organ Waitlist (NOW) and the Highly Sensitized Patient (HSP) program. The three registries are now more accurately described as a single Canadian Transplant Registry that serves three interprovincial programs for organ listing and sharing: the LDPE now renamed the Kidney Paired Donation program the NOW and the HSP program. These programs and the Canadian Transplant Registry are guided by interprovincial policy and informed by evidence-based leading practices developed collaboratively. Point-of-service data from program activity is exchanged with the web-based Canadian Transplant Registry, which will ensure that system reporting is more timely and readily available going forward. The Quebec government also participates through a separate agreement with Canadian Blood Services, making this a truly pan-canadian endeavour. Today more than 100 leading transplant practitioners across Canada with support from our experts, as well as from organ procurement organizations and health ministries work together to bring greater transparency and traceability to the interprovincial processes for managing waitlists and sharing organs. The Kidney Paired Donation (KPD) program extends the transplant possibilities for prospective kidney recipients who have willing but incompatible donors. Since 2010, all provinces, including Quebec, have participated in the KPD (formerly the Living Donor Paired Exchange). The program enables matches among multiple donor recipient pairs, as well as anonymous non-paired donors, making possible domino chains of kidney exchanges. By the end of March 2014, the KPD had facilitated more than 250 kidney transplants across the country. Making it possible to perform over 65 transplants annually requires extensive matching, modelling and management of pairs work that is coordinated by Canadian Blood Services and executed in partnership with the program team The National Organ Waitlist (NOW) program is a real-time online waiting list for patients in need of heart, lung, liver, pancreas or bowel transplants. Leaving behind an antiquated paper-based system, transplant programs and organ procurement agencies can now search a web-based registry of nearly 1,000 potential recipients. The comprehensive listing of all transplant candidates makes it possible to obtain a true national picture of current wait times and access to organs for transplantation. The national Highly Sensitized Patient (HSP) program, launched in 2013, tracks and facilitates matches for transplant candidates who are at high risk of rejecting kidneys because of increased antibodies from past exposures to foreign tissue, typically through pregnancy, transplants or blood transfusions. The larger the pool of participants, the greater the likelihood that a successful match will be found. As of June 2014, program members across the country are able to work together more effectively to find these challenging matches. The Canadian Transplant Registry provides all three interprovincial programs with real-time access to information, including significant transactional and point-of-service data to support listing, allocation and reporting which, in turn, can inform far more robust national reporting on donation and transplantation. Data and analytic services will continue to evolve in the coming year. 20 Canadian Blood Services Annual Report

23 Building future value starts with nurturing today s best ideas. System sustainability is not just a matter of securing the supply chain and fine-tuning our services. We re dedicated to encouraging innovation and sharing new approaches, both within our organization and throughout the global health-care community. Mark Berrigan, employee We work every day to extend the impact of what we do far beyond our organizational footprint. As we ve mapped out our strategy for delivering value, the final critical component is a renewed focus on groundbreaking investigation and the sharing of leading practices with our partners in health care. Over the past year we restructured our centre for innovation to better leverage our strengths in three key areas: research, product and process development, and knowledge mobilization. We ve proposed a comprehensive program focused on utilization management. Working closely with major hospitals across the country, we can help to develop guidelines for using blood products more efficiently and effectively. We are now working with governments to plan collaborative efforts in this area so that together we can promote leading practices that balance productivity gains with the highest standards of care. All of our research and education initiatives are aimed at achieving the best possible patient outcomes. In helping innovators make their work more widely accessible, in developing new products and services and in responding to emerging needs within our own organization, our fundamental objective is the same: to get appropriate products or services quickly to the patients who need them and only if they need them. Even when we collaborate on frameworks for the entire blood system, whether focused on blood safety, risk-based decision-making or the economics of service delivery, the final touchstone of value is always the quality of individual patient care. Canadian Blood Services Annual Report

24 Centre for innovation Through our centre for innovation, Canadian Blood Services plays a leadership role in all aspects of research discovery, development and clinical across the spectrum of blood transfusion medicine. Highlights of the past year include: Further knowledge development about emerging technologies in areas such as red blood cell immunocamouflage and intravenous immunoglobulins (IVIG) replacement. Evidence-based data gathered for the Canadian Standards Association to inform changes in red blood cell storage and cryosupernatant plasma regulation. Contributions to several key clinical trials, as well as the publication of systematic reviews and guidelines on clinical practice. The centre allocates information, expertise and funding across three interrelated areas: Research Focus: targeted research to improve the safety and quality of blood products. Goal: promote innovation that addresses the most important clinical, product quality and patient care needs in transfusion and transplantation medicine. Development Focus: applied process and product development driven by research findings and the needs of the blood system. Goal: translate research into new development through innovative problemsolving and process improvements; facilitate design, validation and implementation; support quality-focused operations through the evaluation of product specifications and manufacturing processes; monitor trends, risks and opportunities. Knowledge mobilization Focus: acquiring, evolving and translating knowledge to advance patient care and help shape policy and clinical practice. Goal: share knowledge nationally and globally to promote excellence in transfusion and transplantation medicine and in the commercialization of processes and products. The centre for innovation regularly develops ResearchUnits plain-language summaries of recent research and posts them on our website at transfusionmedicine.ca/research-summaries. Also available on the site is an annual progress report reviewing the centre s wide-ranging research, development and knowledge-sharing initiatives. Determination of death In March 2014 the topic of organ donation and death received national media coverage, sparking widespread public discussion. Canadian Blood Services joined the conversation, pointing out that Canada is recognized as a global leader in establishing ethical and medical practices for determining when an organ donor can be declared dead. Indeed, two years earlier, in collaboration with the World Health Organization, we had hosted a highly influential conference on the development of international guidelines for the determination of death. The subsequent conference report, with contributions from renowned experts in critical care, neurology, neurosurgery, emergency medicine and other areas, was released in March As we emphasized to Canadians, current practices in our country are consistent with these guidelines. 22 Canadian Blood Services Annual Report

25 Awards and recognition Dr. Debra Lane, the Canadian Blood Services medical director for Manitoba, received the Ortho Award for excellence in transfusion medicine from the Canadian Society for Transfusion Medicine. A research team led by Dr. Sandra Ramirez was honoured by the International Society for Blood Transfusion for contributing the best paper of the year to the journal Vox Sanguinis. The study of how long red blood cells can be exposed outside a controlled environment could change standards and benefit blood operators worldwide. The Canadian Blood Services direct-response TV Rally campaign earned a Silver at the annual Canadian Marketing Association awards in the Customer Management: Not-for-Profit/Fundraising/ Public Service category. Canadian Blood Services was also recognized with a Bronze for erecruitment in the same category of the Canadian Marketing Association awards. Our online advertising campaign was showcased as a Facebook for Business success story, earning Distinction from the social network. Our online booking solution won a third-place award ($25,000) in the Drive to the Next Million ImagineNation Challenge sponsored by Canada Health Infoway. The GiveBlood mobile application, consistently ranked as Canada s #1 health-related app by the App Store, was recognized with an award for innovative development from the Association of Donor Recruitment Professionals (ADRP). Canadian Blood Services was honoured with an Outstanding Achievement Award from Scotiabank, along with a Customer of the Year Award from software developer Readsoft, for driving efficiency and automation through our new travel and expense card program and for implementing best practices in digital invoice processing. Dr. Graham Sher, CEO of Canadian Blood Services, was named president of the American Association of Blood Banks (AABB); he is the first non-american to hold this position. Leah Hollins, chair of the board of directors of Canadian Blood Services, was recognized with an honorary doctorate by the University of Manitoba. Rabbi Dr. Reuven P. Bulka, a member of the board of directors of Canadian Blood Services, was named to the Order of Canada. Kimberly Young, director, donation and transplantation, at Canadian Blood Services, was named president of the International Society for Organ Donation; she is the first nonphysician and the first woman to assume this leadership role. OneHero.ca, a donor recruiting microsite created by Canadian Blood Services for the OneMatch Stem Cell and Marrow Network, was named Site of the Day by the Favourite Website Awards (FWA). Canadian Blood Services Annual Report