Thursday, May 25, 2017

The sound of silence (Musings on why it's key to criticize TM professionals / organizations)

Updated: 25 May 2017 
(Major revision from the blog initially posted.)

May's blog was stimulated by recent experiences I've had on a transfusion Twitter account. It deals with concerns about professionals speaking their minds versus being silent. As such it's a personal blog but I hope transfusion professionals everywhere will be able to discern the issues involved and how they may relate to their professional lives.

The blog's content is the type of thing folks don't usually discuss except perhaps with their trusted best friends (or in social media speak, their BFF).

Executive version: The blog is about decisions made on Twitter and on transfusion-related blogs like this one, which occasionally make me persona non grata with fellow tweeps and colleagues. The blog's focus is about the need for transfusion professionals to speak out and discuss the things that bug them, instead of remaining silent.

The blog's title comes from a Simon and Garfunkel song, circa 1965.

So readers can appreciate the context of where I'm coming from and what has shaped my views, some background.

In brief, I'm a lifelong medical laboratory technologist who began my career as a 'kid' at Canada's then national blood supplier (Canadian Red Cross) in Winnipeg in the pre-AIDS era that blood bankers often call the 'golden age of serology'. CRC is where I grew up professionally and the Canadian Red Cross Blood Transfusion Service (CRC-BTS) staff became my beloved blood banking family. The learning opportunities were abundant because Winnipeg's CRC-BTS was, and remains, the only combined blood supplier-transfusion service in Canada. Many of the staff became lifelong pals.

Later I lucked out by getting a teaching position as a lecturer, then professor, in the MLS program at the University of Alberta in Edmonton and a clinical instructor for the UAH blood bank, positions held for 22 years. I called these positions the best transfusion science teaching job in Canada, maybe the world, before choosing to give up a tenured university position to embark on new adventures.

With this background I've seen many changes, some I judge as good, some as bad, and been a keen observer of our profession for decades. Transfusion medicine remains a lifelong love affair.

It's obvious, but please be aware that what follows is my perspective and, as such, shows my biases.

As noted earlier, my TM career began with Canada's blood supplier CRC-BTS, now CBS. After being a med lab tech, lab supervisor, and clinical instructor at CRC-BTS, decades later I was privileged to obtain many consultant jobs with CBS - I loved them all - and briefly served as a lab manager of a CBS patient services lab. It's an organization Canadians can be proud of but, like any large organization, is not perfect.

Over the years I've criticized CBS on Twitter and in blogs for what I perceive as deception, hypocrisy, use of hackneyed business jargon, and more.

Some tweets I've made often occur on the spur of the moment and constitute errors in judgement. Some are because, as a bit of a contrarian, I see things differently than many or choose to reveal my true feelings on issues that others do not for whatever reason.

Reminds me of advice I'd give to Med Lab Science students:

Explaining how feedback is an indispensable tool to help both instructor and learner improve, and modelling appropriate responses such as, "Thanks for telling me that." When MLS students enter their clinical internship year, I'd explain that constructive criticism is their best friend. They can improve only if supervisory staff tell them when they are doing something wrong or doing something that needs to be improved.
That said, does CBS even want feedback from the likes of me, especially when it's often critical of their practices or constitutes a send-up? Perhaps not.

Sad but tweets about CBS could potentially cause folks I respect to unfollow me on Twitter. I know of at least one in the UK who has done so.

The blogs are a different matter. They're not spontaneous but a way to get something that bugs me off my chest. In a way they're therapeutic. I blog about an issue and feel better because I've said my piece and haven't remained silent. Often I wonder how the heck I've had the chutzpah to criticize a respected organization and its leaders.

So the question arises, is it preferable to keep silent or continue to challenge CBS to be even better? Or are blogs and tweets similar to pissing in the wind?

Fact: Most transfusion professionals choose to keep silent and not criticize organizations such as national blood suppliers for several reasons. First and foremost, the organization may be their employer. Or perhaps they interact with the blood supplier as a hospital client and want to maintain a cordial relationship. 

But the result is that the blood supplier often never knows where they need to improve because no one dares to tell them. Certainly rank-and-file employees usually don't. Reality is many employees outside an inner circle at head office, or not in management positions in blood centres, have long since given up offering feedback about policies because it's invariably ignored. At least it seems that way to 'trench workers'.

Directives and self-congratulatory missives emanate from CBS head office that staff in the far flung regions sometimes consider a joke, often so hypocritical that the missive is the exact opposite of reality. I could write a lot more on this from my experiences as a CBS lab manager but won't now.

Why should we offer honest feedback to TM colleagues and organizations? Because it's the only way they can improve. If we only promote what a great job they do, they will NEVER improve. And I want the organization I grew up in and love to improve.

As to errors in judgement, those mistakes are what I must learn from. If I've inadvertently offended colleagues, I apologize unreservedly. Being passionate about a subject can sometimes push me to say dumb things.

Does any of this resonate with your experiences? Are you deep into the 'sound of silence' as many, perhaps most, transfusion professionals are? Food for thought that I hope is palatable and doesn't cause you to choke.

This Simon and Garfunkel song fits this blog. TM professionals and organizations who might improve - if only colleagues would speak inconvenient truths - never can improve if the Sound of Silence reigns in the TM community.


  1. Anonymous7:27 PM

    Although its becoming more difficult in todays environment of "bully management", history has demonstrated that people in the know should not be afraid to, or be prevented from speaking out.

    Looking back on our history one can imagine how the impact of the Tainted Blood Tragedy may have been lessened if more people in the know would have stepped forward.

    It's often not easy to say what's on your mind and be judged by your peers but it's necessary if we expect to continue improving.

    I may not agree with everything you write but I applaud you for having the courage to make your views known.


  2. Thanks, Ian. Interesting that you use the term, 'bully management'. In one of the CSTM 'I will remember you' blogs, a noted Alberta blood banker and past CSTM President noted, "I hope the situation in Alberta changes, but in the last few years of my employment with AHS, there was an overwhelming culture of DON'T question any changes, keep your head down, don't make waves and don't rock the boat."

    I observed worse when becoming a lab manager at CBS in 1999. A respected director from head office visited and speaking to the lab technologist who had supervised the lab before I came on board (but it was no doubt for my ears too), said in an unpleasant and threatening manner something similar to, 'You know, this lab operation is not on board with CBS's plan to cut costs and be more efficient.' The bullying message was to shape up or else.

    That small anecdote has stuck with me because the organization touts just the opposite.

    Agree that the Tainted Blood Tragedy may have been lessened if folks in the know had spoken up. We'll never know. But from reading the Krever Report it seems that many physicians, including Red Cross medical directors, accepted the 'word from above' and acquiesced to what they thought head office wanted.