Sunday, December 11, 2011

You're so vain: What we've got here is failure to communicate (Musings on the CBS-NB 'blood feud')

See Update below.


This month's blog features a 'blood feud' in New Brunswick (NB), Canada, following a 2009 decision by CBS to close its blood component production and distribution centre in Saint John, NB. Instead, blood collected in NB will be processed and distributed by a CBS plant in Dartmouth, Nova Scotia, a neighbouring province.


NB has 3 options:
  1. Go it alone with an independent NB blood service
  2. Partner with Héma-Québec, Canada's other blood supplier
  3. Stay with CBS
The blog's title comes from Carly Simon's signature hit You're so vain and an ironic, hilarious quote from Cool Hand Luke.(Roger Ebert's 1967 review)

If you are not Canadian, the blog should still appeal since its themes are not so much the specifics of the argument (interesting in themselves), but musings on poor communication and arrogance, my take on how such a soap opera could arise between Canada's national blood supplier and the province of NB and its physicians.

Frankly, it's an embarrassing farce that is all too common elsewhere (not specifying where) but rarely occurs in the Great White North. Am I showing my arrogance?

Because of the planned Saint John closure, NB is considering breaking away from CBS, the national blood supplier. On the surface it seems a no-brainer to stay with CBS, one of the most respected blood suppliers in the world. So what went wrong?


According to my musings, the main cause is
  • Communication failure, against a backdrop of
  • Cost constraint and consolidation
  • Arrogance and non-responsiveness
  • Concern for patient safety and loss of expertise
  • Parochial politics
Disclaimer
Over many years I worked in multiple capacities for CBS and its predecessor, Canadian Red Cross BTS, which means nothing except that I know the organization, have biases (pro and con) because of that, and have friends who work there. The same applies to colleagues who work in hospital transfusion services. Admittedly, I sometimes use hyperbole as an attention-grabber.
Rest assured that anything written in blogs is not personal, but not 'strictly business,' either, since I blog for fun. Rather the ideas are, as the blog's name states, musings, i.e., the results of personal contemplations that flow across the universe, which may or may not be unfolding as I think it should. (grin)
As to this blog, I have no inside knowledge of the particulars and muse solely from what's in the news and what I perceive from afar about the players involved. I could be 100% wrong. 
BACKDROP - Cost constraint and consolidation
In brief, CBS has been consolidating services (its core 'business lines', as it likes to say) for many years as reported in Performance Review of CBS (2002). See section 2.6. 


At the time CBS priorities included (p.65):
  • Implementation of MAK Progesa
  • Creation of a National Donor Contact Centre
  • Consolidation of Testing Centres
  • Consolidation and Specialization of Production
  • Implementation of a Change Control System
  • Unrelated Bone Marrow Donor Registry
  • Implementation of SAP HR/Payroll
Most of the projects have now been completed, the exception being 'Consolidation and Specialization of Production.'

Perceived (or real) arrogance and non-responsiveness
Clearly, based on their experience over closure of the Saint John processing and distribution facility, NB health professionals perceive CBS as arrogant. Quotes:


Non-Partisan Task Force. Reversal of Canadian Blood Services’decision to consolidate blood production services to Dartmouth, Nova Scotia. Report to the Legislative Assembly of New Brunswick, April 16, 2010
1. Under Outcomes of a meeting June 15 -16, 2009 with CBS: "The task force and stakeholders expressed concern with the lack of preparedness and the condescending tone of CBS officials."
2. Under Oct. 2009 meeting content: [Note: Margaret Ann Blaney is a Member of the NB Legislature and co-chair of the task force]:
Margaret Ann Blaney suggested that the task force write a letter to the CBS Board of Directors expressing the concern that the task force has with the manner in which the task force and the medical community have been treated by CBS staff. The feeling is that the CBS staff has been patronizing and has a predetermined agenda that will not be changed.
Margaret Ann Blaney expressed that Dr. Graham Sher, the CEO for CBS, has truly abdicated his responsibility and the consolidation of production, lack of public consultation and the condescension demonstrated by Dr. Sher goes against the recommendations made in the Krever commission report.
Concern for patient safety and loss of expertise
The plan to close the Saint John production facility has been protested from the start by NB health professionals on the basis of patient safety and loss of local expertise:
In 2010 the head of the Medical Staff Organization for the Saint John region carried these concerns to CBS headquarters in Ottawa and reported that CBS clearly had no intention of reversing its decision.
"We have the provincial cardiac surgery program and all of the surgical tertiary care: complex orthopedic surgery, vascular surgery, neuro surgery, general surgery, complicated head and neck surgeries for cancer . . . .
We have blood production facilities right across from the hospital that are second to none where we can access product and where they can call in donors when needed and produce the blood right here rather than having to contact someone outside the province who doesn't know our needs and, frankly, would probably be taking care of other needs first." (Dr. Andrea Garland)
Parochial politics
Politics is a common lurker in any fight involving locals and a big "other." Local politics cannot help but be involved anytime a national organization decides to withdraw services from a region.

Saint John newspaper supports dropping CBS
"In the opinion of many physicians, leading businesspeople, such as Gerry Pond, and former CBS manager Dan Connolly, New Brunswick gets insufficient credit for its substantial contribution to this national blood system."
'The empire strikes back'
Forced by their own actions into being reactive, CBS responds with a multi-pronged counterattack:
BOTTOM LINE
So, what to make of it all? To me, the key factors (root causes) are



1. CBS failure to communicate the validity of the planned change and how it will benefit the people of NB, not just CBS.

We assume that CBS leaders are excellent communicators. They
  • Manage a staff of 1000s
  • Spend a kazillion hours in meetings (presumably not comatose)
  • Liaise with diverse levels of government, private sector suppliers, colleagues in hospital transfusion services, the public, and more
  • Speak at local, national, and world congresses
  • Get elected to high office in leading professional associations
But perhaps they have communication weaknesses, as shown by the NB fiasco. 

When you're the top dog, the acknowledged experts, perhaps you think that you don't have to be flexible, empathetic, good listeners, to say nothing of being humble?



2. CBS arrogance
Based on feedback from the NB physicians, it's possible that CBS did 
  • Not sufficiently listen to the concerns of local physicians
  • Not convey respect for the views of health professionals on the front lines in NB
  • Not truly listen to others, due to believing in the absolute correctness of its position
What is arrogance? It can be defined as 
  1. Insulting way of thinking or behaving that comes from believing that you are better, smarter, or more important than other people (source)
  2. Someone who believes they are always right, and better than everyone (source)
In a way, it's easier to dislike arrogant people who are smart than those who are dumb, as cleverly stated by Nietzsche:
  • "Arrogance on the part of the meritorious is even more offensive to us than the arrogance of those without merit: for merit itself is offensive."
And when proud, competent people perceive arrogance in others, they get their backs up and tend to think, "I'll show that arrogant 'bleep'!



In this way, arrogance does the arrogant in. Because they believe they are always right, they don't truly listen to differing opinions and give them credence, despite celebrating that they do. Put another way, they do not walk the talk. Accordingly, they seldom, if ever, modify decisions, once taken.



Fact is, arrogant individuals in positions of power seldom focus on the needs of others, seldom have and show empathy, seldom validate the opinions of others.

When caught in the act by fellow health professionals, CBS has been  reduced to sending open letters to the people of a province.

Hence the blog's title:
FOR FUN
Another Strother Martin quote from the same film, this one about understanding the rules of the game. Maybe NB docs didn't understand the rules, i.e., CBS decides without consultation and is obeyed?
Songs that come to mind:
As always the views are mine alone. Comments are most welcome BUT, due to excessive spam, please e-mail me personally or use the address in the newsletter notice. 


I'll update the saga as it evolves. My guess is that NB will opt to stay with CBS, as it's a no-brainer. 


Update