ARCHIVED - Summative Evaluation of the Blood Safety Contribution Program - Final Report

 

Appendix A: Detailed Key Findings

This section presents the key findings for each of the evaluation questions.

Appropriateness of Target Audiences and Activities

Evaluation question 2: Are the BSCP target audiences and activities appropriate in light of societal/environmental requirements?

This section presents findings associated with the design of the program, and the extent to which that design is appropriate in light of the programs stated goals. It includes discussion about the extent to which the program’s activities respond to identified needs, and if the program is targeting the people who need to be involved in order to respond effectively to those needs.

BSCP Target Audiences

Stakeholders are people who have a stake or a vested interest in the program. The program’s target audiences are those stakeholders who are actively engaged in the program in some way (e.g., by helping to deliver the program, implement the surveillance systems, or use the surveillance data). The BSCP iRMAF/RBAF (2008) indicates that BSCP has involved the following key stakeholders or target audiences:

  • Health Canada;
  • Funding recipients (Provincial and territorial governments, Not-for-profit organizations, Designated transfusion/transplantation centres, and agencies or groups designated by Ministries of Health to undertake surveillance);
  • Federal/Provincial/Territorial Public Health Authorities (e.g., Council of the Chief Medical Officers of Health);
  • Public Health Practitioners;
  • Blood, Blood Products and CTOAR Transplantation originators (CBS, Héma-Québec, Major hospital-based tissue banks, Organ donation organizations, CTOAR processors/ importers/distributors);
  • Disease Specific Organizations (e.g., Canadian Hemophilia Society, Kidney Foundation of Canada, Canadian Liver Foundation.);
  • Academics (e.g., Canadian Institute for Health Information, Major teaching hospitals in Canada, Institutions which collaborate with PHAC concerning risk assessment, National/international experts in blood transfusion or transplantation surveillance);
  • Professional Associations (e.g, Canadian Standards Association, Canadian Public Health Association, Canada Medical Association, Canadian Dental Association, Canadian Nurses Association, Canadian Patient Safety Council); and
  • Other key influencers in the public health environment, including decision-makers and Canadians, particularly patients who receive blood, blood products and CTOARtransplants.

Most of the survey respondents and all interviewees who were asked about the target audiences believed that the BSCP’s current target audiences were completely appropriate, with about one third of survey respondents believing that the audiences were only partially appropriate. None indicated that the target audiences were inappropriate.

Several survey respondents and a few interviewees suggested additional groups who should be involved in the BSCP. Of those suggested, the following merit further exploration regarding fit and potential contribution:

  • Related Societies and Associations (i.e., Canadian Society of Transfusion Medicine, Canadian Society for Medical Laboratory Science; Canadian Paediatric Society; Association for Medical Microbiology & Infectious Disease (AMMI Canada);
  • International collaborators’ groups (i.e., EHN, WHO, AABB, ISBT, CDC/FDA, etc.);
  • All teaching hospitals in Canada;
  • Provincial Lab Quality Assurance Program;
  • Other groups within the federal government doing similar kinds of work (e.g., groups that look at HIV or divisions within Centre for Infectious Disease Prevention and Control); and
  • Internal staff with specialized expertise within BSCP (e.g., statistician modeller, epidemiologist with blood and/or transfusion expertise).

Two expert panellists also suggested ongoing communication with the public health agencies of other countries.

It is worth noting that PHAC had attempted to engage several additional stakeholder organizations as a part of the TOSS Steering Committee. Some organizations either indicated that they were unable to participate or did not respond to the PHAC’s invitation. These included: the Canadian Society of Cardiac Surgeons, the Canadian Society of Plastic Surgeons, the Canadian Cardiovascular Society, and the Society of Obstetricians and Gynaecologists of Canada (Tissues and Organs Surveillance System. Consultation: September 2007 – March 2008, 2008, p. 6).

BSCP Target Activities

BSCP has involved the following activities:

  • Providing funding, through contribution agreements, for provinces and territoriesto establish and maintain surveillance activities for adverse events and errors related to blood / blood product transfusions and the transplantation of cells, tissues and organs;
  • Encouraging linkages with public health to enable identification of adverse events outside the hospital reporting system;
  • Establishing national tools and standards for surveillance;
  • Providing funding for research projects related to high risk populations and emerging pathogens;
  • Coordinating standing committees and working groups to support the establishment, monitoring, and ongoing use of the surveillance systems; and
  • Coordinating ad-hoc committees to address emerging issues.

The combination of the above activities appears to appropriately complement the ‘key ingredients of effective and timely surveillance’, articulated in the PHAC Strategic Plan 2007-2012, which include: strong partnerships with provincial and territorial governments; a combination of robust and flexible systems with people who know how to use them; data collection, sharing and management across jurisdictions and settings; expert analysis and interpretation; and communication with public health partners. Effective and timely surveillance is described as key to the federal government’s and provinces/territories’ ability to accurately track, plan for and respond to diseases (p. 24).

Almost all of the survey respondents thought that the BSCP activities were the right activities for improving transfusion and transplantation safety, with only about 1 in 10 indicating that they were partially the right activities and none indicating that they were not the right activities. There was also a high level of agreement among the PHAC staff interviewees that the BSCP involves the right activities. Expert panellists also felt that these were generally the appropriate activities to be undertaken in support of the BSCP’s stated goal ‘to improve the safety of transfusions and transplants in Canada’.

While there was a strong indication of the appropriateness of BSCP’s activities, both interviewees and survey respondents provided suggestions that built on BSCP activities. Some survey respondents and interviewees provided suggestions for how to strengthen existing activities. These included:

  • Increase attention and promote the need for research projects that utilize data;
  • Reword ‘Encouraging linkages with public health’. The word ‘establishing’ could be more appropriate, as it is more action-oriented;
  • Ensure linkages are also made with the private health sector (e.g., dentists, private clinics and private hospitals); 
  • Establish mandatory minimum standards for TTISS, TESS and CTOSS;
  • Look at the data in a more integrated way during NWGTTISS meetings (i.e., across provinces and territories);
  • Reconsider whether BSCP should operate on contribution agreements or some other agreement (such as Memorandum of Understanding); and
  • Implement a process to capture delayed adverse events related to infectious complications.

Others provided suggestions for new activities that should be undertaken as part of BSCP. These included:

  • Develop policy recommendations or guidelines based on TTISS data (e.g., the data can be used to recommend that all provinces put into place formal Informed Consent to Transfusion processes, or to develop guidelines for blood products that do not have any guidelines);
  • Prepare journal articles based on the data collected;
  • Examine how current activities coordinate or compare with similar types of activities in response to other public health concerns (infectious diseases and conditions – e.g., HIV, SARS);
  • Increase linkages with interrelated public health issues such as nosocomial infection or tuberculosis. This could also expand into common or standardized software systems used for reporting on a variety of patient/public health issues;
  • Use a public reporting mechanism (e.g., website) to track and report blood surveillance events and errors as is done with nosocomial infections; and
  • Develop programs to address the generic issues that lead to the risks identified through the BSCP.

Summary

There is broad agreement that the BSCP involves the appropriate target audiences and activities.

The stakeholder groups who are actively engaged in the program in some way can be considered target audiences. Based on the document review, these include: Health Canada; funding recipients; Federal/Provincial/Territorial public health authorities; public health practitioners; blood, blood products and CTOARtransplantation originators; academics; professional associations; and other key influencers in the public health environment. Most stakeholders believed that the BSCP’s target audiences are appropriate, if the goal is to improve the safety of transfusions and transplants. However, there may also be the potential to include some other target audiences.

The core activities of the BSCP are to provide funding, through contribution agreements, for provinces and territories; encourage linkages with public health; establish national tools and standards for surveillance; provide funding for research projects; coordinate standing committees and working groups; and coordinate ad-hoc committees. Most stakeholders believed that the BSCP’s activities were appropriate, if the goal is to improve the safety of transfusions and transplants. Again, there may also be the potential to expand on certain current activities and add additional activities.

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