Photo of blood recipient and volunteer, Deborah Hunte

Annual Report 2013 – 2014

Delivering Value

It’s always been at the heart of our purpose.

Today it’s how we define success in everything we do.

Enter

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.

Value

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.

Three illustrated icons of medical professionals and a patient demonstrating better care, better outcomes and optimal costs

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.


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, 2014. 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.

Strategy

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)

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

Providing clinical services

Including registries, medical services, knowledge, tools and expertise

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:

1Improving patient outcomes through the manufacturing and delivery of safe, relevant, quality products and services to Canadians.

2Continually earning the right to serve through our commitment to safety, performance improvement, and responsible and accountable financial management.


“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.

“ I tell people who have never donated that now is the time to help, because you never know when it could be you needing blood.”
Brent Cairns
Donor, peer recruiter
Photo of Brent Cairns, a blood donor and peer recruiter
“ I tell people who have never donated that now is the time to help, because you never know when it could be you needing blood.”
Brent Cairns
Donor, peer recruiter

Not many people can say they grew up in the world of blood donor clinics. But because Brent’s mom, Deb, has worked for the blood system for more than 18 years, it has been a part of his world for as long as he can remember. So much so that he didn’t give a second thought to celebrating his 17th birthday at a clinic making his first blood donation. Although he recently lost his grandfather to cancer, Brent saw first-hand the difference blood transfusions made as his grandfather was going through chemotherapy and this, too, had an impact. While attending university, he was very active in encouraging his fellow students to donate, using social media to spread the word and remind people of the importance of donating, not tomorrow, but today.

Structure

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.

Photo of Riley Knowles, volunteer, pushing two halves of an illustrated building together, like puzzle pieces
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.

Process

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.

Photo of Nancy MacNeil, employee, walking with illustrated footsteps trailing behind her
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.


Illustration of four people holding pencils with check marks above them

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.


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.

Read more about the enhancements we’ve made:

Illustration showing how Canadian Blood Services tracks a blood donation from donation to testing, to entering information by computer into inventory, to delivery to hospitals

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.

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.

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.

The new production and distribution facility in Dartmouth, Nova Scotia

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.

“ 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
Photo of Canadian Blood Services donor and volunteer Dennis Koebel
“ 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

What started out as an excuse for a 16-year-old student to get out of class turned into a full-time commitment for retired elementary school principal Dennis Koebel. He became a regular blood donor after his mother developed ovarian cancer and needed blood, and got more involved with the blood system as the years went on. He’s organized a “Blood Brothers” group of friends that meets every 56 days on Saturday mornings for breakfast, followed by a visit to the clinic to donate blood. He goes out of his way to encourage others to donate, even marking milestone events like his 100th donation or Christmas parties by having them at the clinic and asking others to join him. He is also a member of Canadian Blood Services’ Regional Liaison Committee and sits on the National Liaison Committee.

Products

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.

Photo of Jeanette Posey, volunteer, holding an illustrated clock
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.


Read more about how we get people the products they need:

Illustration of two Canadian Blood Services staff receiving cord blood donations from two mothers, with a path leading to a building

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 2014.

Group photo of 25 climbers holding a Canadian Blood Services flag at the summit of Mount Kilimanjaro

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.

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.

Quality

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.

Photo of Ellen Flores-Abad, employee, climbing up illustrated steps to show progress
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.

Illustration of five people with thumbs-up signs in front of them expressing their approval

82%
Trust Rating

In our annual survey of Canadians’ trust in the blood system we scored two points higher than our 80% target for 2012–2013.


Read more about two important quality-related issues:

Illustration of a Canadian Blood Services truck making a u-turn

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.

“ Several of my 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
Photo of blood recipient and employee Melissa Smith-McGuire
“ Several of my 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

As a territory manager for Canadian Blood Services, Melissa Smith-McGuire is responsible for ensuring seats are filled at blood donor clinics to meet the demand for blood. She knows better than most how essential blood donations are for saving lives. Her mother needed blood several years ago for a number of medical emergencies, including a heart attack, internal bleeding and surgery to have a kidney removed. Her cousin needed blood for a double-lung transplant in the spring of 2014, and Melissa herself received blood during childbirth. Not many can say they have seen first-hand the need for blood on such a personal level as Melissa, but for her, this makes her job that much more rewarding.

Donors

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.

Photo of Tyler Dorey, employee, and Dave Thomson, volunteer, standing in front of two intersecting coloured circles
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.

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.


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 2014. 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.


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.

Illustration of segments from a sample population to demonstrate the size of different groups of donors (each group is represented by different colours)

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.

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.


The Donor Life Cycle

Illustration with coloured circles corresponding to the stages in the donor life cycle

  1. 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)
“ 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
Photo of blood and stem cell donor Kabir Chughtai
“ 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

Having been a regular blood donor for many years, Kabir felt the next logical step for him was to join the OneMatch Stem Cell and Marrow Network. A few years after joining, he learned he was a potential match for a patient in urgent need and didn’t hesitate to help. Kabir drove six hours from his home in Saskatoon to Edmonton to attend his medical assessment, taking his three children along for the journey. Once it was confirmed he was a match, he drove back to Edmonton and donated his stem cells with his wife by his side in late 2012.

Transplantation

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.

Photo of employee Heather MacDonald standing in front of a grey circle, and her daughter, blood recipient Alexis MacDonald, standing beside her in front of a blue circle with an arrow between them to show their connection
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 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.


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%
Proportion of male registrants, of whom 16% are under age 36. The latter group represents optimal donors, as stem cell transplants from young men result in fewer complications and better patient outcomes.

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, from ethnically diverse backgrounds or of mixed ethnicity.

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.

1000
Approximate number of Canadians currently on waiting lists for suitable unrelated donors. The total number of patients seeking life-saving stem cell matches has tripled over the last five years, making the national public cord blood bank more needed than ever.


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 system-wide 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.

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 2014. As we emphasized to Canadians, current practices in our country are consistent with these guidelines.

Innovation

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.

Photo of Mark Berrigan, employee, looking up at an illustrated light bulb
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.

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:

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.


  • 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.
  • 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).
  • 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.
Photo of Leah Hollins, chair of Canadian Blood Services board of directors and Dr. Graham Sher, Canadian Blood Services chief executive officer

CEO/Chair Message

Delivering value

A message from our chair and our chief executive officer

During the past year, Canadian Blood Services continued to build on the solid record of performance we’ve maintained since our founding in 1998. Collaborating closely with our stakeholders, we met and surpassed our targets in key areas such as operational efficiency and hospital satisfaction levels – while working as always to ensure the safety and effectiveness of the products and services we provide to health-care systems across Canada.

This sustained momentum, however, must be seen in the context of our times. The provincial and territorial governments that fund Canadian Blood Services, still challenged by the severe fiscal restraint of recent years, have no choice but to intensely scrutinize every tax dollar invested in health care – and this pressure shows no sign of abating. At the same time, we work with our funding partners in a political climate that demands the highest standards of transparency and accountability from any organization supported by public money. Canadians rightly expect us to be exemplars of sound governance and responsible management while providing a solid return on their investment.

How do we define value?

Delivering value has been central to our purpose from the day we assumed responsibility for operating Canada’s blood system. In highlighting this aspect of our mandate, we must begin by defining what value means in health care. Value cannot be appraised simply by looking at a balance sheet. Optimal cost-efficiency is just one facet of a three-sided model that gives equal importance to the effective delivery of care and the improvement of patient outcomes.

The opening sections of this annual report explore all three dimensions of the value we deliver – not as an abstract ideal, but through the concrete steps by which we put our strategy into action, along with the tangible results that our collective efforts produce. As both a manufacturer of biological products and a provider of clinical services, we gauge our progress by how effectively we help deliver quality care and contribute to better outcomes while optimizing the impact of every dollar spent.

Measuring our performance

Our activities over the past year yielded many objective measures of success. In the area of service delivery, for example, we achieved a 98 per cent satisfaction rating among major Canadian hospitals. And as an illustration of our progress in the realm of patient care, we increased the number of registered stem cell donors by nearly 10 per cent, boosting the treatment prospects for potential recipients across the country. That outlook will further improve as we continue to build Canada’s national public cord blood bank, which opened its first collection and processing facilities in Ottawa in the fall of 2013.

As for the fiscal dimension of value, we will reduce our administrative staff costs through the elimination of some 100 full-time-equivalent positions. This year, we reduced and avoided costs associated with new contracts for plasma products. We expect to save or avoid an average of about $120 million in costs compared to what we would have paid annually, assuming foreign exchange at parity. Over five years, the total savings will amount to approximately $600 million from this year through to 2018.

Inviting an outside review

To validate our internal performance measures with a third-party assessment, in 2011 the board of directors voluntarily proposed a collaborative independent review of our operations. This comprehensive assessment was conducted by Ernst & Young from October 2012 through March 2013, and the results were summarized in a report tabled the following May.

The report concluded that the majority of Canadians continue to trust in the safety of the blood system and believe that Canadian Blood Services, as the steward of that system, acts in their best interests. The external consultants’ analysis found that we excel in several key areas: the safety and reliable supply of products, hospital satisfaction, stakeholder engagement and transparency, and the achievement of cost-efficiencies. The report also set out 79 recommendations identifying areas of potential improvement in our organization, as well as in the provincial and territorial health ministries. Most have already been implemented, and work on the remainder is well underway.

The performance review focused in particular on the relationship between Canadian Blood Services and our funding partners, underlining that we must continue to collaborate on improving system performance while remaining “independent parties, operating at arm’s length, in a mutually respectful fashion.” We are now in discussions with our funders on how to better delineate our complementary roles. From our perspective as an independent provider, we are responsible for managing our operations with full transparency and accountability under a clearly defined governance model. Our funders, for their part, see the benefits of safeguarding our independence while defining the parameters of our mandate, along with all aspects of health policy and the expenditure of public funds in their jurisdictions. As a result of our ongoing dialogue, we hope to see a collaborative pan-Canadian accountability agreement in place by the spring of 2015.

A strategy for change

A big part of delivering value is looking for opportunities to add value wherever we can. In our focus on quality, for example, we not only provide safe, effective products and services but also offer expert guidance on how to maximize their impact, whether we’re advising front-line physicians on the use of specific fresh blood components or sharing insights with health-care leaders on improving utilization.

Equally crucial, as we extend our positive contribution across the spectrum of Canadian health care, are the great strides we’ve made this year in restructuring our organization. As a biologics manufacturer, we’ve applied the principles of integrated supply chain management to every area of operations, from the lifetime relationships we build with donors to the fine-tuning of countless process steps that help ensure we always get the right product to the right place at the right time. And as a provider of clinical services, from organ donation registries to innovative research and education programs, we evaluate success in terms of our ultimate impact on the lives of patients in need.

What frames all of our efforts is a well-defined strategy – grounded in experience, adaptable to changing needs and aimed at achieving what has always been our overarching goal: delivering value to Canadian health care and to all Canadians.

Dr. Graham Sher
Chief Executive Officer

Leah Hollins
Chair, Board of Directors