|Year : 2019 | Volume
| Issue : 2 | Page : 32-38
Improvement of platelet supply by the project research quality control circle and win-win team model in a hematological department
Qianli Jiang1, Chengpu Yu2, Leyi Chen3, Xiaorui Cui4, Yanyan Chai5, Zhengyuan Wang5, Quanfeng Chen3, Maoyu Qin3, Maoyuan Wang3, Wenyuan Li6, Tingfang Liu7
1 Department of Hematology, Nanfang Hospital, Southern Medical University, Nanfang Hospital, Southern Medical University, Guangzhou; Institute for Hospital Management, Tsinghua University, Shenzhen, China
2 School of Sociology and Anthropology, Sun Yat-Sen University, Guangzhou, China
3 The First Clinical Medical College, Southern Medical University, Guangzhou, China
4 School of Public Health, Southern Medical University, Guangzhou, China
5 Department of Hematology, Nanfang Hospital, Southern Medical University, Nanfang Hospital, Southern Medical University, Guangzhou, China
6 Department of Presidentfs Office, Nanfang Hospital, Southern Medical University, Nanfang Hospital, Southern Medical University, Guangzhou, China
7 Institute for Hospital Management, Tsinghua University, Shenzhen, China
|Date of Submission||02-Mar-2020|
|Date of Decision||27-Mar-2020|
|Date of Acceptance||30-Mar-2020|
|Date of Web Publication||28-Apr-2020|
Institute for Hospital Management, Tsinghua University, No. 2279 Lishui Road, Nanshan District, Shenzhen 518055
Prof. Wenyuan Li
Nanfang Hospital, No. 1838, Guangzhouda Road, Baiyun District, Guangzhou 510515
Source of Support: None, Conflict of Interest: None
Objective: Platelet is a crucial medical resource to ensure the quality and patient safety in healthcare. A project research Quality Control Circle (prQCC) was applied to this platelet shortage challenge in a level 3 Grade A hospital of South China. Materials and Methods: (1) A prQCC team was established based on the win-win team model. (2) By system diagram analyzing, the prQCC focused on improving the donation of the society. (3) The differences between regular donors and ordinary volunteers were analyzed using questionnaires, and four strategies were integrated and implemented according to the analysis of the requirements from donors and volunteers. (4) The platelet supply as well as tangible and intangible achievements were collected and evaluated. Results: More donors were recruited, including 313 ordinary volunteers and 76 regular donors, 226 units of platelets were donated directly. The platelet supply in the department of hematology has increased to 121.95% (from 4792 to 5844 units) versus 105.56% (from 9488.5 to 10016 units) in the hospital. Each participant of this prQCC benefited from tangible and intangible achievements, with a closed win-win loop formed. Conclusions: The prQCC is an efficient tool to improve platelet supply; and the win-win team model is also potentially useful in other areas of quality in healthcare, and thereafter worth spreading.
Keywords: Platelet supply, professional volunteers in healthcare, Quality Control Circle, Win-Win Model
|How to cite this article:|
Jiang Q, Yu C, Chen L, Cui X, Chai Y, Wang Z, Chen Q, Qin M, Wang M, Li W, Liu T. Improvement of platelet supply by the project research quality control circle and win-win team model in a hematological department. QAI J Healthc Qual Patient Saf 2019;1:32-8
|How to cite this URL:|
Jiang Q, Yu C, Chen L, Cui X, Chai Y, Wang Z, Chen Q, Qin M, Wang M, Li W, Liu T. Improvement of platelet supply by the project research quality control circle and win-win team model in a hematological department. QAI J Healthc Qual Patient Saf [serial online] 2019 [cited 2020 Sep 25];1:32-8. Available from: http://www.QAIJ.org/text.asp?2019/1/2/32/283453
| Introduction|| |
Blood, especially platelet, is a crucial medical resource to ensure the healthcare quality and patient safety. For example, hemorrhage due to low platelet counts is responsible for 62.2% death of leukemia patients, and platelet transfusion is the first choice in such life-threatening clinical situations.,, However, the platelet shortage is a great challenge in many developing countries.
Since 1998, China started a voluntary blood donation and stopped compensating blood donation. After that, voluntary platelet donation numbers increase rapidly, but with the development of economy, urbanization, and comprehensive coverage of health insurance in China, contradictions between demand and supply of platelet happened quite often in some areas and specific periods, especially in certain metropolis., For example, Guangzhou, which is the central city and the medical center of South China with a population of 14 million, has the second-largest platelet donation number nationwide. Even though the numbers keep increasing dramatically year by year, the platelet supply is still not enough because the numbers of beds and inpatients grow even faster every year. In the year of 2016, its platelet supply reached 83,695 units, but the average daily platelet supply is only 229.3 units and there are 258 hospitals in Guangzhou, which means <1 unit can be distributed to per hospital averagely according to the data from Guangzhou Blood Center. The study hospital has the greatest platelet requirement in Guangzhou while the hematological department consumes ≥50% platelet of this hospital. Handling with platelet shortage in hematological department is extremely urgent.
Quality Control Circle (QCC) is a form of tool to solve quality problems with team cooperation according to the certain procedure. Normally, the QCC team consists of people working in the same or similar occasion., The application of QCC in the medical area has thriven rapidly in mainland China since Professor Tingfang Liu introduced QCC to mainland of China in 2004. It has played an important role to improve the medical quality., QCC can be divided into two types, problem-solving QCC and project research QCC (prQCC). prQCC is going to achieve breakthrough improvement in an unknown area, or to create surprising quality in certain fields. To break the shortage of platelet is such a hard task that the authors had to choose prQCC by QC story judging.
In the past 6 years, the authors had developed a kind of win-win team model for QCC, which has been proven to be effective in solving such complex problem as minimization of the perianal infection rate of hematological malignancies with agranulocytosis. Conventionally, hospital staffs directly communicate with patients, but the relationship is not easy to balance due to hospital staffs' lack of time and resource and the patients' lack of knowledge. Our previous study has showed that medical students and social workers with professional knowledge who are also called professional volunteers in healthcare (PVH), can be the ideal third party to balance the interests and coordinate each participant. The win-win team model should incorporate as many as stakeholders of a system and try to attain a stable triangle relationship. Therefore, PVH was enrolled into the traditional blood donation chain to optimize the process and establish a win-win team model.
In this study, prQCC and win-win model were applied to analyze and solve the problem of platelet supply and improve the process of platelet donation. Tangible and intangible achievements were obtained, and each participant of the platelet donation chain got benefits from this study.
| Materials and Methods|| |
The prQCC was implemented in a level 3 Grade A hospital of South China, from September 2016 to August 2017.
Plan – Quality Control Circle team establishment
The QCC team was consisted of three doctors, four nurses, three medical students, two social workers, and patient volunteers, according to the win-win team model.
Plan – Theme selection
When following up the 265 patients died in hematology in authors' hospital from January 2005 to December 2014, 36.23% of patients died of hemorrhage and 2/3 died of infection. Since a QCC to minimize the perianal infection in the department of hematology has been done as mentioned before, the theme was selected as “to improve the platelet supply in the hematology department” with 5-3-1 rule.
Plan – Time table setting
The time table has lasted for 1 year, including four stages: (1) plan (including QCC team setting, theme selection, plan setting, analysis, objectives setting, and strategy formulation) for 10 weeks, (2) do for 32 weeks, (3) check for 26 weeks (run in parallel with do stage), and (4) action for 6 weeks.
Plan – System analysis and questionnaires
From the brainstorm of QCC team, the system diagram was drawn, which focuses on the main reason of platelet shortage [Figure1]. Volunteers can be divided into regular donors (having experience of platelet donation for at least twice and having willing to redonate in ½ a year) and ordinary volunteers (includes nonregular platelet donors and those who cannot donate but would like to help platelet donation). Questionnaires were conducted to explore the profound needs and worries of both regular donors and ordinary volunteers.
Plan – Strategy formulation and target setting
Traditional platelet donation chain was analyzed. Then, four-specific strategies were integrated for better improvement based on profound needs and worries found to deal with insufficient supply of social donation.
Based on the questionnaires, the profound reasons of “insufficient platelet donation of society” were summarized [Figure 2] and four strategies were implemented.
|Figure 2: Analysis of insufficient platelet donation of society by the systemic diagram|
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- Establishing a PVH team: PVH team, who has professional medical backgrounds and good service abilities, plays as the neutral and professional third party between the suppliers (social donors and blood center) and demanders (patients and hospitals) of platelet
- Popularization: PVH team and volunteers together with staffs from blood centers held all kinds of activities, including lectures, competitions of short videos, and talk shows. For better spreading, not only platelet donation knowledge but also other aspects' knowledge in the healthcare were popularized
- Building up an intelligent management volunteer bank: regular donors and ordinary volunteers were recruited online or offline, thorugh blood donation sites, lectures in universities and social communities, etc., Ordinary volunteers can be transformed into regular donors, and they also can carry out questionnaires surveys and provide a better service to regular donors
- Setting up a new platelet donation spots or improving the service of spots: the PVH team and ordinary volunteers collaborated with blood center to set up a new spots and to improve the donation process and health-care service to both regular donors and ordinary volunteers.
The effects of the four strategies were analyzed. The platelet supply of hematological department before and after the prQCC was compared. Benefits of each stakeholder (hospitals, patients, blood centers, PVH, and society volunteers) in the platelet donation model were measured, such as satisfaction, academic outcomes, and personal development.
PVH is introduced into the traditional platelet donation chain as the third party to prompt efficiency and self-generating ability, then, the win-win model was setup.
Results are expressed in the form of percentages and numbers. P value was performed with Chi-square test by SPSS 24.0 (IBM, Armonk, NY, USA). Values of P < 0.05 were considered statistically significant.
| Results|| |
The prQCC use the systemic diagram to analyze the cause of platelet shortages [Figure 1]. It is found that the foremost factor of platelet shortages is insufficient social donation.
Questionnaires were sent to volunteers to figure out basic characters, needs, and worries of regular donors and ordinary volunteers. Most of regular donors and ordinary volunteers' donation motives are to help others, but the platelet donation rate of ordinary volunteers is only 5.26%, which is quite low comparing with regular donors. About 57.62% of regular donors and 31.58% of ordinary volunteers are looking for better health. Therefore, health is the greatest common divisor of both.
People aged between 18 and 25 years old and female (gender) take a major proportion of ordinary volunteers. But they are less likely to become regular donors [Table 1].
|Table 1: The comparison of basic characters of regular donors and ordinary volunteers|
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The worries and needs are investigated so that more ordinary volunteers can be transferred to regular donors [Table 2]. The need of more detailed instruction for donation procedure, food and water provision during donation, and the worry of time waste are similar in regular donors and ordinary volunteers.
|Table 2: The worries and needs of regular donors and ordinary volunteers|
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Based on the questionnaires, the profound reasons of “insufficient platelet donation of society” were summarized by systemic diagram again, the relationship between reasons and strategies was displayed as the following.
After completing the four strategies in plan–do–study–act (PDCA) model, authors have attained some tangible and intangible achievements, which is in conformity with the win-win purpose and also meet the needs and worries of volunteers.
- Platelet supply in the hematological department has increased to 121.95% (from 4792 to 5844 units) in the department of hematology versus 105.56% (from 9488.5 to 10016 units) in the hospital
- More donors were recruited, including 313 ordinary volunteers and 76 regular donors. Two hundred and twenty-six units of platelets were donated by the volunteer bank directly
- Four natural and social foundations were approved, including two national and two provincial foundations, and two academic articles were published, and one national invention patent was approved
- Forty-six popularization activities were carried out, and nine public reports and television interviews were published on the local and national newspapers and new media.
With platelet supply increased, the qualities of patients' life have been improved. In popularization activities initiated by PVH teams, family members, and patients also play an important role on the platelet supply increasing by spreading knowledge of platelet donation as well as other knowledge in healthcare.
The quality was improved by obtaining more platelet with limited energy and time costs, and the QCC team members became more confident and happier, burdens of medical staffs were released. Such training and experiences are also good to other quality improvement.
Although there was no financial feedback, the PVH was still satisfied when involved in the public welfare. By exercising their comprehensive abilities in science research and complex problem-solving, especially for medical students, they got chances to work together and gained valuable capabilities in PVH team.
The updated platelet donation chain with the PVH helped the blood center to harvest more platelets. By deeper understanding of their demands, blood centers can enlarge and maintain the regular donors' bank efficiently.
PVH can help the blood station to provide more health-care service to regular donors and ordinary volunteers, with the setting up of a few new platelet donation spots, which can encourage them to donate platelet. The service during donation also can be improved by introducing more professional volunteers; the number of regular donors and volunteers keeps increasing.
Action: The transformation of current platelet donation chain to win-win model
The existing platelet donation chain mainly driven by the public welfare and an improved win-win model is shown in [Figure 3]a and [Figure 3]b. Every stakeholder can get more than before since it is a sustainable win-win model.
|Figure 3: (a) Current platelet supply chain: it is hard to form a close loop. (b) PVH-win-win team model for platelet donation: A stable triangle relationship formed among small loop of PVH blood center hospital as well as large loop of PVH society (donors) patients|
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| Discussion|| |
To increase the platelet supply, prQCC was proven to be a powerful tool to analyze and solve this problem. QCC is good at improving quality from bottom up since it can collect the wisdom of frontline workers by greater extents and provide more feasible protocols with limited costs. Based on PDCA cycle, QCC members can summarize the deficiencies of each PDCA and help to improve in the next cycle. Through brainstorms and systemic diagrams, “insufficient platelet donation of society” is the main reason of platelet shortages so that more ordinary volunteers should be transferred to regular platelet donors since regular donors play a more important role. Then, questionnaires were sent to regular donors and ordinary volunteers to find out their differences of characteristics, needs, and worries. With those findings, more effective strategies were carried out, and the platelet supply was increased in the end.
Traditional platelet donation chain in China is composed of society (donors), blood centers, hospitals, and patients [Figure 3]a. Social volunteers initiate platelets donations to blood centers, then blood centers distribute platelets to each hospital, and finally, patients receive a platelet transfusion. This process is heavily dependent on public welfare and government extra investments. Since patients can do little feedback to society (donors), which means it is hard to form a “closed loop.” In this regard, conventional platelet donation chain is like a one-off transaction to some extent. From the authors' study, what the regular donors needs most is service and ordinary volunteers needs most are knowledge popularization and safety guarantee. These findings are consistent with other researches., Those demands are difficult to be satisfied by the current system, although the greatest efforts have been made with many resources.
PVH was introduced into the traditional platelet donation chain by QCC [Figure 3]b. The prQCC team in this project consists of medical staffs, students, and social volunteers, who were also the majority of PVH team in this study. Medical students and others who have sufficient knowledge and with more spare time were recruited into PVH team and work together with doctors. They are good at popularization, volunteer recruitment, providing professional service for volunteers, and encouraging patients and their friends to participate in platelets donation-related activities. With a stable triangle relationship formed among small loop of PVH blood center hospital as well as large loop of PVH society (donors) patients, the platelet supply has increased in the hematological department and the hospital, patients' urgent needs for platelet are replenished, while PVH members develop their ability and being more confident, and the pressure of medical staff in hospitals and blood station were alleviated and be happier. In a word, when PVH was introduced, a real self-driven win-win “closed loop” is formed without too much resources devoted.
More importantly, health-care system is going to be transformed from treatment centered to health centered in the medical reform of China. From the authors' study, many volunteers cannot donate platelets due to their unhealthy physical conditions, which mean they are “no useful” and cannot be encouraged in the current donation chain. Such large number of volunteers in the bank does not participate in donation directly, but they also can play important roles in the whole health-care system. According to the medical reform, traditional blood/platelet-centered model should also be shifted to a health-centered model. For example, PVH can provide a health guidance service to help volunteers be more physical and mental health, then they will be more capable and willing to donate platelets in author's win-win model.
Obviously, there are some defects in this project. The increase of the platelet supply is still limited, and the prQCC integrated with PVH win-win model still needs more multiple center experiments in the future.
| Conclusions|| |
The prQCC is an efficient tool for improving health-care quality and patient safety such as increasing platelet supply. Win-win team model is reproducible and sustainable, not only in such blood donation problem but also in other health-care areas of quality improvement, therefore worth spreading.
Many thanks to Qifa Liu, Yuting Liang, Juanjuan Wu, and Xinmeng Fan (Hematological Department of Nanfang Hospital, Southern Medical University), Qiufan Chen, Xiaoping Li and Zhihao Zheng (Southern Medical University and BBCn volunteer team) for arrangement of platelet donation and popularization. Thanks a lot to Pingling Hu and Ping Xiang (Nanfang Hospital, Southern Medical University), Yue Zhang, Ying Zhang, and Yingshi Wu (Southern Medical University and PVH volunteer team) for the data analysis and valuable suggestion to article writing.
Financial support and sponsorship
This work is supported by the patient-hospital Growth Support Volunteer Project for Guangdong Volunteer Service Organization in 2018 (No. 2933 and No. 3294), Science and Technology Planning Project of Guangdong (No. 2018A070701006), The Natural Science Foundation of Guangdong Province (No. 2018A030313647) and Special Fund for Scientific and Technological Innovation and Cultivation of Guangdong University Students (Climbing Plan) in 2019 (No. pdjh2019b0101).
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2]