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I would like to start with the problem that confronted the National Blood Authority (the NBA) in 2003.
We were a new organisation, set up by all Australian governments to improve the management of the blood supply, and, in particular, to get better value for money for governments’ expenditure on blood products, both fresh blood components and plasma-derived and recombinant products.
While a competitive procurement process can improve the value of what one buys, for most purchases we had no choice but to negotiate with monopoly providers in Australia.
Some of these were very sophisticated and well resourced global companies.
On the other hand, few of the NBA’s 35 staff members had any knowledge or background in blood products or the industry, and there was virtually no publically available independent information on the sector.
When your job is to secure your country with a high quality supply of blood products, the stakes are very high.
How you do your job is critically important for patients who, in many cases, depend on those products to stay alive. For others, product availability directly affects their quality of life.
A good outcome is critical for the Australian tax payer too; the cost of our blood products is around three quarters of 1% of our national health budget. So if too much is spent on blood products, other health services suffer.
So what did the NBA do in response to our problem?
We started by buying market intelligence from consultants. This was helpful, but only covered some of the knowledge we needed and for a short period. It was not a long term solution.
I also visited a number of plasma and recombinant fractionators and manufacturing facilities in Europe and provided very comprehensive reports back to staff at the NBA on what I had learned.
Given that the industry is a highly competitive commercial market, I was surprised at how much intelligence I was able to gain from the people that I visited.
Next, the NBA established documented processes for our key business functions. These were the functions, like blood product procurement, that were the most important things we needed to do, and we would do them repeatedly.
These Key Business Processes ensured that we captured both the knowledge we were progressively obtaining, as well as fulfilling our compliance responsibilities.
Then we appointed a retired academic as our intelligence officer.
Professor Bambrick performs horizon scanning by conducting web searchers of company announcements, medical journals, financial markets and a range of other information sources. She distributes a regular flow of information to relevant staff and compiles summary reports every two months for our government stakeholders and the NBA’s Advisory Board.
In 2007 we reviewed our actions to date and, following consultation with staff, developed a comprehensive corporate capability strategy. This strategy identified the key capabilities that the NBA needed to do our job consistently at a high standard.
One of these capabilities was our civil and private knowledge network and I shall talk more about this later.
Other key capabilities we required included:
Having knowledgeable staff is very important for the NBA. As part of our corporate capability strategy we undertook staff surveys that assessed the skills and knowledge that staff needed, and what our current levels were. The gaps identified then influenced our recruitment, induction and training strategies.
For example, as part of our training commitment we run a Knowledge Management Forum every fortnight with speakers from within and outside the NBA; the latter include clinicians, blood suppliers, representatives from patient groups, and public sector experts. These speakers include international visitors.
We also recognised that we needed IT and systems support to capture, manage, and allow staff to access the knowledge that was acquired. One tool which we implemented successfully to achieve this was a web search engine that allowed staff to find the information they needed from the NBA’s documented knowledge base.
The remaining two capabilities we identified as critical for the NBA were the capacity for the organisation to re-develop itself and the ability to monitor and manage performance.
Before I go much further, it might be worthwhile saying a little bit about Australia and the environment in which the NBA operates.
Australia covers a large geographic area and has a population of 22 million. As the interior of the country is largely dry and infertile, most of the population is located along the east coast.
Australia comprises six states and two major territories, each with their own regional government which takes major responsibility for hospital services.
As the NBA takes national responsibility for blood management, we frequently have to take into account significant jurisdictional differences, as well as deal with logistical issues around long distances and high temperatures.
The NBA was established in 2003 to bring a national approach to the supply and purchasing of fresh blood components, and plasma and recombinant blood products.
As well as responsibility for buying all the products, we need to make sure that the supply of products is secure, both on a day to day basis and in times of crisis.
Our third major area of work involves working with all levels of government to improve the clinical use of blood and blood products.
In Australia, all blood and blood products are provided free to patients and in 2009/10 Australia expects to spend around $A910 million on blood products ($US 765 million).
The NBA’s organisational goal has been
“to build and maintain an organisational capacity so that we can consistently perform at a high standard.”
When the NBA started in 2003, we were immediately faced with the task of negotiating new arrangements for the supply of all the blood products that we use in Australia, as well as developing a national blood supply contingency plan and commencing work on improving blood usage.
At this point I will explain a little more about our knowledge network, which has been key to the NBA’s success.
The NBA has two key readily accessible repositories of knowledge: Firstly, the knowledge that staff themselves possess; and secondly, knowledge found in documents within the NBA.
As I mentioned above, a search engine allows NBA staff to access documented knowledge.
Documented and staff knowledge is augmented by a steady stream of material from various sources, including:
This regular stream is supported by information gained through our active programme of engagement with both domestic and international knowledge network members.
Engagement with domestic stakeholders occurs through regular forums, and through consultation on particular NBA activities.
Typically the NBA will issue a discussion paper whenever we are contemplating a new activity such as new procurement, or reviewing existing activities. We always receive a great deal of constructive feedback from our stakeholders. Domestic stakeholders include patient groups, the clinical community and blood suppliers.
The NBA also engages with business analysts advising the investment industry. Their information is particularly important as they are able to interpret the information they receive from the suppliers and translate it into valuable advice on cost and pricing trends.
The information we receive from suppliers can be influenced by the outcome they are seeking to achieve. Our existing understanding of the sector (including the commercial strategies of the various suppliers), plus the fact that we get information from multiple sources, allows us to assess the potential bias in this information so that it still contributes to our knowledge base.
The experience of other countries is hugely useful and in 2008 the NBA created the international collaboration of National Plasma Products Supply Planners (NPPSpa).
This group of five countries has an interest in purchasing and/or planning for plasma and recombinant blood products and meets annually to exchange information. NPPSPa extends, in a more formal and sustainable way, bilateral exchanges that the NBA had undertaken in previous years.
This group improves our flow of knowledge of the global plasma industry, provides a forum for dialogue on policy development, performance benchmarking, technological advances, product demand, pricing and supply availability.
So has the work of the NBA to develop and utilise a private and civic knowledge network been particularly innovative or novel?
Perhaps!
Firstly, we have developed the NBA as an organisation in which knowledge is valued and staff are expected to gain and use subject matter knowledge rather than just manage processes.
For example, tender process managers can use market forces to achieve what they think is the best price for a particular blood product.
But if you understand the market, you will know that the price and range of products submitted in response will be very much influenced by how and what you ask for, e.g. how much you want, the timing of your approach to the market, the period of supply, how quickly you want delivery, the risks that you take or transfer to the supplier, and your expectations of service.
Secondly, we have sought to acquire knowledge through effective engagement with citizens rather than buying intelligence or using complex data bases or systems to store knowledge.
We know that the knowledge we need exists in the community and is often freely available to us if we know how to access it. Stakeholder consultation can be much richer than just seeking other views and opinions.
A key aspect of what we have done is to use multiple sources of knowledge. This reduces the risks with only collecting information from limited sources and also mitigates the risks of potential bias in the information we receive.
The knowledge network works most effectively if it is part of a comprehensive organisational capability strategy.
Finally, underpinning knowledge acquisition with well documented Key Business Processes (KBPs) allows us to integrate the knowledge we gain into those processes to allow for better application of that knowledge to future tasks.
What were the obstacles and how were they mitigated?
As a small organisation we had limited scope to increase resources to gain the knowledge we needed.
Our solution was to build in knowledge expectations into the way we work, hire staff and induct them into the organisation
We learnt early on that having a single source of knowledge, such as purchased reports and advice from consultants, creates difficulties once that source disappears.
Instead, we access multiple flows of knowledge on a continuous basis, thus ensuring the knowledge remains current and timely.
Creating a centralised structured knowledge bank within our IT repository was tried but failed. How one structures information might work well for the person who creates it, but frequently not for the next person. Our solution has been to expose staff to knowledge as it enters the organisation and then allow access by a user-friendly IT search tool.
Probably the hardest obstacle has been to create a culture that values knowledge acquisition.
We sometimes find that new staff have come from an environment where knowledge acquisition was not a priority. The processes that we have in place encourage a change in attitude over time. We also measure commitment to gaining knowledge and skills as a key organisational performance indicator and this emphasises to staff the importance we place on it.
The major lesson learned is that knowledge management requires a clear, consistent vision, strong leadership and commitment.
As staff are vital to this success, you must ensure that the processes and policies within the organisation reinforce this commitment
An innovative approach to recruitment, which targets staff interested in working in an environment that expects a collaborative and open approach to the capture of information and knowledge, has been one way we have achieved this.
Having an open dialogue with staff is also vital and allows management to address major issues such as privacy, confidentiality and conflict of interest.
By embedding the knowledge network initiative into the culture of the organisation, we are ensuring that its benefits are retained and enhanced as the NBA continues its work and evolves in response to changes in the external environment.
One delightful lesson we have learned is the enthusiasm of members of our civic and private knowledge network to share their knowledge with us. Often they feel honoured. Always we are grateful.
The difference that the NBA work has made to the health sector is now visible and we are confident that “making a difference” is a motivator for both staff and our external partners in the knowledge network.
Technologies can deliver huge benefits – and we use technology for the knowledge that it delivers - but it is not a substitute for having knowledgeable staff who can apply that knowledge to the work of the agency.
Our knowledge network and approach to organisational capacity has delivered major benefits for Australia.
Most importantly, since the NBA started in 2003, we have been able to provide a secure supply of high quality blood products to meet clinical needs at all times.
The NBA has developed more robust risk analysis and risk mitigation strategies, based on an in-depth understanding of how products are used, the supply chain, and product production.
This knowledge informed the development of the NBA’s National Blood Supply Contingency Plan which was activated in October 2008 in response to a domestic shortage of red cells. Measures undertaken in accordance with the Plan ensured there were no disruptions to clinical practice.
Consultation frameworks, inventory analysis and other mechanisms developed for the Plan are also used to monitor the impact of any international or national catastrophe on blood demand and to take actions to reduce the possibility of the Plan’s formal activation.
These were effectively tested in response to a number of emergencies in 2009, such as the Victorian bush fire disaster, the tsunami in Samoa, earthquakes in Sumatra, and the H1N1 (pandemic) outbreak.
Significantly, the knowledge network initiative has also allowed the NBA to negotiate contracts that provide higher quality and safer blood products at reduced prices.
We estimate that this saved governments just under $A40 million (US$33 million) in 2008/09, compared to previous arrangements. This is despite global prices rising significantly over this period of time.
In addition, we are confident that we have been able to drive improvements in the clinical use of products through a number of clinical guidelines that we have sponsored over the years.
The benefits achieved by the NBA have been acknowledged by independent government reviews and success in awards.
These awards have had a tangible effect on staff morale, have further endorsed our business practices and have provided opportunities to share the knowledge and experiences of the NBA since we started in 2003.
Thank you
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