John, I think that many Blood banks in the UK now have automation and provide blood by EI . The workload increase has come about with the introduction of the Blood Safety & Quality Regulations in 2005, and having to have a proper quality system in place, which some labs had to absorb as part of the normal workload without a proper quality structure for Pathology. Managers not only had technical, financial and HR responsibilities but a full QMS to deal with too without adequate support. There are sites which up to a few years ago had no documented training records, SOPs, , audits , change control, validations, let alone incident reporting to the depth we now need to do this. Haemovigilance reporting in the UK (SHOT) has for 20 + years reported that upto 50% errors causing patient harm originate in the lab- but still many labs were/are not addressing these issues (or even reporting!). Issues with staff culture is also a significant factor - and some people are resistent to improve.