Who leads BT?

[Bill Chaffe]

Would love to know how many Lead BMS's in BT are NOT responsible to a colleague in Haematology

[L106]

Bill - Could you please spell out what "BMS" and "BT" mean? Thanks!

[Malcolm Needs ☆]

Bill - Could you please spell out what "BMS" and "BT" mean? Thanks!

BMS is Biomedical Scientist (Technician) and BT is Blood Transfusion.

:):)

[jcdayaz]

Bill,

What do mean by "responsible" to a colleague in Hematology?

If you mean do Blood Bankers report to them, then my answer is NO! If the Hematologist detects a significant change in CBC reults it is their obligation to come to us to verify transfusion--not the other way around.

(Hope I didn't misinterpret your question)

[Malcolm Needs ☆]

Bill,

What do mean by "responsible" to a colleague in Hematology?

If you mean do Blood Bankers report to them, then my answer is NO! If the Hematologist detects a significant change in CBC reults it is their obligation to come to us to verify transfusion--not the other way around.

(Hope I didn't misinterpret your question)

I think what Bill is getting at (correct me if I am wrong Bill) is that, in the UK, the Blood Transfusion Laboratories in the Hospitals are very often run by a "senior" Biomedical Scientist (who may well be an expert in Blood Transfusion matters), but who has to report to a "chief" Biomedical Scientist in Haematology (who may well be an expert in Haematological matters, but who may well be "pretty average" in their knowledge of Blood Transfusion).

In other words, the real expert in Blood Transfusion is responsible to, and subordinate to a Biomedical Scientist in Haematology, who may not have an in depth knowledge of Blood Transfusion.

Is that correct Bill?

:confused::confused:

[Steven Wiltshire]

In the larger Trusts the position is changing rapidly with the advent of Blood Sciences. The Transfusion Lead will be answerable to either a Laboratory Manager (often Haematology but could be Chem Path) or possibly a Pathology Services Manager (all disciplines), not forgetting the ominous lurking presence of the Clinical Scientists.

However good news: the reporting to HTC and hence to Patient Safety Committee (often chaired by the CEO) is a good way of keeping issues live. The presence of excellent Transfusion Practitioners (thanks to NPSA & NHSLA level 3) keeps higher management aware of issues. The MHRA have given weight to many arguments and we have all benefitted from new equipment, and written the risk assessment, change control, validation masterplan, contingency plan, new SOP, periodic review etcetera etcetera (watch out...bulging shelf at breaking point...document overload) to go with it!

Mixed news: Is it all getting divisive? As combined Blood Sciences fill with Band 4 staff but BT looks at recent publications in the IBMS gazette re training requirements I see a gulf developing between BMS staff which I do not approve of. Perhaps Transfusion BMS staff will become the new Clinical Scientists...........Perhaps the NHSBT will employ us all..................Happy New Year

I recommend a good Chair for the HTC (Anaesthetist if possible), Good Transfusion Consultant Lead, Good overall Haematology Lead, Good Transfusion Practitioner and justified arguments: Play the risk transfer game i.e. put risk in writing and get manager above you to take it on

[L106]

I assume Bill is specifically interested in how the lines of responsibility lie in the UK, but I will mention that the most common managerial arrangement in the US is that each of the laboratory sections (ie: Blood Bank, Chemistry, Microbiology, Hematology, Histology, Cytology, and larger institutions may have other specialty areas) has an individual "in charge" (the terminology varies), and those individuals report to a single individual who is responsible for the entire Lab (usually called something like "Laboratory Director".)

[RR1]

In my current post a lot of the problems I experienced in the last two years were due to the line management structure. Even though I am the lead in the blood transfusion dept, my operational line manager was a Haematology BMS ( who was also the line manager for the Haematology and Biochemistry leads).

Now he has left, I report directly to the Path Services manager, but this will all change back to the original structure when a new OPs manager is employed... so things could deteriorate again in the near future.

[jcdayaz]

In other words, the real expert in Blood Transfusion is responsible to, and subordinate to a Biomedical Scientist in Haematology, who may not have an in depth knowledge of Blood Transfusion.

:confused::confused:

Yuck. I don't like this scenerio at all. To be considered a subordinate to someone who knows only basic blood banking would feel like an insult!!

[Malcolm Needs ☆]

Yuck. I don't like this scenerio at all. To be considered a subordinate to someone who knows only basic blood banking would feel like an insult!!

I have been in that position, and believe me, not only does it feel like an insult, IT IS AN INSULT!

:angered::angered:

[RR1]

I agree Malcolm! I would think a vast majority of labs in the UK are structured in this way, and this is possibly what is causing delays with improvements we are all trying to make.

It might be useful to add a poll to your question Bill.

[jcdayaz]

BMS is Biomedical Scientist (Technician) and BT is Blood Transfusion.

:):)

BMS...is that the equivalent to our "Medical Technologist"/"Clinical Lab Scientist"??

These titles here in the US require at least a Bachelor's degree from college and a certain amount of time doing an internship in a designated hospital lab. My internship was @1 1/2 years at 5 different hospitals!!!! (UGH, I thought I would have been able to block that from my memory by now...:D:D:D)

[Malcolm Needs ☆]

BMS...is that the equivalent to our "Medical Technologist"/"Clinical Lab Scientist"??

These titles here in the US require at least a Bachelor's degree from college and a certain amount of time doing an internship in a designated hospital lab. My internship was @1 1/2 years at 5 different hospitals!!!! (UGH, I thought I would have been able to block that from my memory by now...:D:D:D)

Yes, except now, to get above the basic grade, you need a Master's (unless you are as old as me - this came in after I got to Chief).

[Malcolm Needs ☆]

I have been in that position, and believe me, not only does it feel like an insult, IT IS AN INSULT!

:angered::angered:

To follow up my own post (sorry), I will give an example.

During my career, I have had the misfortune to have dealt with at least five major incidents. These included three bombs, when the IRA were operating in London, and two train crashes.

On the fourth occasion, despite the fact that I was nominally in charge of the Blood Bank, the person in charge of Haematology (who was my line manager, and who knew basic blood transfusion, but who had never dealt with a major incident in his life) happened to be around, and "took charge".

I cannot give too many details, otherwise personal identities would be revealed, but suffice it to say, the result was near chaos, and the victims survived "despite", rather than "because of".

This sounds very egocentric on my behalf (for which I apologise), but it was, nevertheless, true.

:mad::mad::mad::mad:

[jcdayaz]

To follow up my own post (sorry), I will give an example.

During my career, I have had the misfortune to have dealt with at least five major incidents. These included three bombs, when the IRA were operating in London, and two train crashes.

On the fourth occasion, despite the fact that I was nominally in charge of the Blood Bank, the person in charge of Haematology (who was my line manager, and who knew basic blood transfusion, but who had never dealt with a major incident in his life) happened to be around, and "took charge".

I cannot give too many details, otherwise personal identities would be revealed, but suffice it to say, the result was near chaos, and the victims survived "despite", rather than "because of".

This sounds very egocentric on my behalf (for which I apologise), but it was, nevertheless, true.

:mad::mad::mad::mad:

Not egocentric at all Malcolm...THE TRUTH!!! NEVER apologize for telling the truth!!

Sometimes I wonder how any patient actually makes it out of the hospital !!!

I have been known to "buck the system" so to speak, when someone in charge is making a wrong decision. "Wrong" not in my opinion only, but just plain wrong. I haven't always been the most favored employee of my past supervisors, as you can well imagine! I have had to simply refuse on at least 4 occasions (that I can remember) to follow an order by a boss. Sometimes when I would show proof of why I did it, the issue would just magically disappear. Other times it didn't. But you know what? I am going to take care of my patients no matter what the consequences are.

There are a multitude of things I don't know about Blood Banking. I will be the first to admit it! I still learn on a daily basis. But what I know, I know and I will fight for patient safety any day!!!!!

[Steven Jeff]

I would like to put the other side of this discussion for the sake of balance but do bear in mind that I do understand where most of you are coming from. As some of my UK colleagues know I am the manager of a small multidisciplinary pathology team covering all pathology disciplines except Histology and Cytology on-site. My own training is in Haematology and Blood Transfusion before obtaining my fellowship in Haematology. My interest in blood transfusion has developed more so in the last 15 years. However, I am the responsible manager for Microbiology and Clinical Chemistry too, and I can tell you I do not even pretend to know more about microbiology than my lead BMS in microbiology whom I support in her role. Surely that is the art of management when you have a staff of highly specialised scientific staff, using their expertise. Most of you are trained scientists in your own field and will understand the basics of the other disciplines to be able to make some judgements. I now have an interest in Blood Transfusion, but as soon as I am out of my depth I would certainly approach somebody knowledgably than I.

With respect to Bill’s original question, it may be a little research on his part as he is part of the group who are promoting the importance of the Blood Transfusion lead in the UK., who should have equal status with the leads in blood sciences, microbiology, histology etc. and rightly so.

Finally, as one of my former Hospital Managers said to me when describing pathology – ‘It’s a bit of a dark art’ because nobody really knows what goes on in the laboratories. I believe that is how we are sometimes perceived, not helped by some of the TV programs we see.

Steve

:)

[jcdayaz]

Steven,

It sounds like you are one of the "smart" bosses who utilize their personnel when you get out of your realm of knowledge. If that is what you are saying then I applaud you!! It is the non-blood banker bosses who override (or try to) those of us who know a bit about it that I detest!!

As I have said in a previous post...It is the fools among us who don't know when to admit what they don't know.

[RR1]

But what I know, I know and I will fight for patient safety any day!!!!!

Good on you jcdayaz!!!, that's the spirit. However badly any of us are line managed, we are still ultimately responsible for maintaining patient safety, even if this involves us having to 'fight' to ensure this.

[Malcolm Needs ☆]

It is the non-blood banker bosses who override (or try to) those of us who know a bit about it that I detest!!

I can assure you that Steve is one of the good ones!

I know that money isn't everything (although, of course, it helps!), but what really annoys me as much as the non-blood banker bosses who override (or try to) those of us who know a bit about it, but the fact that they also, very often, get paid considerably more than the most senior person in the blood bank, because they "have to look after blood bank too".

In many hospitals in the UK, the person in charge of blood bank reaches a "glass ceiling" in terms of pay, because they will never be able to reach the level of the most senior member of staff in haematology, chemical pathology, microbiology, histology, etc, etc.

:angered::eek::boo::angered:

(JUST) ONE OF MY PET MOANS!!!!!!!!!!!!!!!!

[Steven Jeff]

Thank you for your kind words jcdayaz and your support Malcolm. I fully understand where you are coming from. In the UK however and certainly in my training, Blood transfusion was always part of Haematology and as such reported to the Chief in Haematology and of course the renumeration and the managerial framework reflected this. It should now be recognised as a separate discipline, but the framework within most hospitals cannot support this ideal. We all know the large teaching hospitals have maga-sized laboratories where the lead BMS in Blood Transfusion may well have equal status with the haematology, clinical chemistry leads etc. But what about the remaining hospitals who are in the majority in terms of numbers.

Steve

:)

[Eagle Eye]

Yuck. I don't like this scenerio at all. To be considered a subordinate to someone who knows only basic blood banking would feel like an insult!!

I would feel the same way.

[Malcolm Needs ☆]

Thank you for your kind words jcdayaz and your support Malcolm. I fully understand where you are coming from. In the UK however and certainly in my training, Blood transfusion was always part of Haematology and as such reported to the Chief in Haematology and of course the renumeration and the managerial framework reflected this. It should now be recognised as a separate discipline, but the framework within most hospitals cannot support this ideal. We all know the large teaching hospitals have maga-sized laboratories where the lead BMS in Blood Transfusion may well have equal status with the haematology, clinical chemistry leads etc. But what about the remaining hospitals who are in the majority in terms of numbers.

Steve

:)

In turn, I see from where you are coming Steve, but I would argue that Agenda for Change should have sorted out these discrepancies, but recognise that this has, in no way, happened.

:(

[jcdayaz]

Thank you for your kind words jcdayaz and your support Malcolm. I fully understand where you are coming from.

You are welcome. I meant every word of it!!

If a person is in charge and has an "issue" and doesn't consult his/her senior Technologist in that particular discipline....well, I don't have much to say to that "person in charge". Except maybe...go work at McDonald's...(sorry...bad)

[RR1]

Apart from the monetary issues, the incorrect line management structure of the transfusion lead means that significant problems may not be brought to the attention of the right people (the Pathology Governance/ Hospital board ). To have to go through complex line management structures just makes it even more difficult when trying to make improvements or highlight concerns, especially if any of these managers refuses to take issues seriously.

I have recently learnt (and stil am!) how very important it is to have a working management escalation/ communication policy in place, where everybody signs up to their responsibilities, and folk can then be held accountable if they don't act on information given to them, about any problems in the lab that can't be sorted due to lack of resources.

[jcdayaz]

I assume Bill is specifically interested in how the lines of responsibility lie in the UK, but I will mention that the most common managerial arrangement in the US is that each of the laboratory sections (ie: Blood Bank, Chemistry, Microbiology, Hematology, Histology, Cytology, and larger institutions may have other specialty areas) has an individual "in charge" (the terminology varies), and those individuals report to a single individual who is responsible for the entire Lab (usually called something like "Laboratory Director".)

Yes! Each department has their own Lead Technologist here. Blood Bank, Microbiology, Chemistry, Hematology/Coagulation/Urinalysis, Histology and Cytology. Each "Boss" for each department reports to our laboratory manager when necessary.