The secret to successful change: "the three Ds".

To be successful, our organizations must become more comfortable with and committed to the change process. Change-readiness and change-adeptness will be required. Successful change depends largely on the organization's ability to recognize and act on what can be called the "Three Ds": Discontent, Decision, and Determination. We have to feel discontent first before we can undergo successful transformation, and then we have to decide to "get different." Deciding to change, however, does not ensure the change will take place unless we demonstrate determination. Following the "Three Ds" may not guarantee success, but it will make certain that you and your organization are well positioned to compete in an ever-changing environment.

Seeking the competitive advantage: it's more than cost reduction.

Most organizations focus considerable time and energy on reducing operating costs as a way to attain marketplace advantage. This strategy was not inappropriate in the past. To be competitive in the future, however, focus must be placed on other issues, not just cost reduction. The near future will be dominated by service industries, knowledge management, and virtual partnerships, with production optimization and flexibility, innovation, and strong partnerships defining those organizations that attain competitive advantage. Competitive advantage will reside in clarifying the vision and strategic plan, reviewing and redesigning work processes to optimize resources and value-added work, and creating change-ready environments and empowered workforces.

Managing change isn't good enough.

One lesson learned from past reengineering is that to be successful in the next decade, organizations will need to create and lead transformation, not just manage the process. Two critical aspects of transformation are that it is a process and that it requires leadership. The "five Cs" of transformation are imperative: create the vision, create the plan, communicate the vision and the plan, cultivate motivated and empowered stakeholders, and cement change in the organization's culture. Business skills, the ability to lead others, and the ability to forge and maintain relationships are needed for effective leadership. For successful transformation, businesses must avoid the mistakes made in the past decade, including too much complacency, too little and/or inappropriate communication, and underestimating the importance of vision and leadership to the transformation effort.

Work process redesign at Vanderbilt University Medical Center's Transfusion Service.

Work process redesign is an effective tool to assist laboratories in identifying areas for improvement. This article presents the experiences and results of Vanderbilt University Medical Center's Transfusion Service in undergoing a work process redesign project to reduce costs and increase growth potential. Opportunities for improvement were identified, and processes were redesigned to enhance efficiencies and increase workload capacity. Areas where opportunities for improvement were identified included work-flow, work process, personnel usage, task delegation, information transfer, physical layout, and communication. The thorough review and redesign of the work processes resulted in a greater demonstrated workload capacity of 381% for pretransfusion testing (antibody screens ABO/D typing, and immediate-spin crossmatches), using no additional FTEs.

Work process redesign for blood banks and transfusion services.

Blood banks and transfusion services generally have been slower than other clinical laboratory areas to look into redesigning their work processes. Work process redesign (WPR) provides a tool for facilities to critically review their current work processes for improvement opportunities. This article provides blood banks and transfusion services with a redesign road map and the experiences of a large, metropolitan transfusion service in undertaking a WPR project.

Be your own best fan.

As clinical laboratory personnel move into the 21st century, these individuals will find a changed workplace. It will be imperative that individuals take responsibility for their own career paths and for promoting themselves as though they were a business entity. Highlighted in this article are the major changes predicted for clinical laboratories. This article encourages clinical laboratory personnel to take ownership of their careers and to develop a strategy for success that includes becoming their own ¿I Am Valuable¿ Team. Included in this article is a discussion of how to manage your career and be your own best fan.

Antibody screening and direct antiglobulin testing using BioVue column agglutination technology versus standard tube tests.

The BioVue column agglutination technology (CAT) was evaluated simultaneously with standard tube test (STT) methodology for use in indirect antiglobulin testing (IAT) and direct antiglobulin testing (DAT). One thousand thirty-five blood specimens were used for the IAT comparison, and 44 blood specimens were used for the DAT comparison. Both polyspecific antiglobulin and anti- IgG antiglobulin reagents were used in the tube testing and the CAT testing. For IAT, sensitivity was 100 percent for CAT and 99.6 percent for STT; sensitivity was 97.9 percent for CAT and 100 percent for STT. In addition, a 67 percent labor savings was realized with CAT versus STT. Specificity and sensitivity of both methodologies were 100 percent for the DAT. BioVue proved to be a reliable and efficient alternative to standard test tube methods for doing IATs and DATs.

Genetic variation in Arizona Mexican Americans: estimation and interpretation of admixture proportions.

Mexican Americans are a numerous and fast growing ethnic population in the United States. Yet little is known about their genetic structure. Since they are a hybrid, it is of interest to identify their parental populations and to estimate the relative contributions of these groups. This information is relevant to historical, biomedical, and evolutionary concerns. New genetic typings on 730 Arizona Mexican Americans for the HLA-A, HLA-B, ABO, Rh, MNSs, Duffy, Kidd, and Kell loci are presented here and they are used to estimate ancestral contributions. We considered both a dihybrid model with Amerindians and Spaniards as proposed ancestors, and a trihybrid model with Amerindians, Spaniards, and Africans as proposed ancestors. A modified weighted least squares method that allows for linkage disequilibrium was used to estimate ancestral contributions for each model. The following admixture estimates were obtained: Amerindian, 0.29 +/- 0.04; Spaniard, 0.68 +/- 0.05; and African, 0.03 +/- 0.02. The interpretation of these results with respect to Amerindian and Spanish ancestry is straightforward. African ancestry is strongly supported by the presence of a marker of African descent, Fy, despite the fact that the standard error of the estimate is as large as the estimated admixture proportion. An evaluation of the sensitivity of these results to a number of variables is presented: 1) our choices of ancestral allele frequencies, 2) the possibility of selection at HLA and the blood groups, and 3) genetic drift in Mexican Americans.

Unusual reactivity of several anti-U serums with red cells from RN persons.

Several examples of anti-U were diluted serially and tested with RN red cells and red cells of various Rh phenotypes from both blacks and whites. The agglutination scores were reduced for U+ red cells from people with RN compared with U+ red cells from whites. U+ red cells from blacks yielded score values greater than red cells from people who inherited RN, but definitely less than U+ red cells from whites. The rank-correlation coefficient (0.92) indicated a p value of 0.0005.

An evaluation of 11 red cell elution procedures.

Eleven elution procedures were evaluated for their efficacy in recovering antibody from red cells sensitized with immunoglobulin. The procedures evaluated included eight published methods (Lui, heat, digitonin-acid, ether, chloroform, dichloromethane, xylene, and alcohol freeze-thaw) and three commercial elution kits (EluAid, Ortho Diagnostic Systems, Inc.; Elution Solution, Biological Corporation of America; and Elu-Kit II, Gamma Biologicals, Inc.). The xylene elution method proved to be the most effective method, followed by Elu-Kit II, chloroform, dichloromethane, and digitonin-acid. The other six methods evaluated were not optimal based on the suitability of each procedure and the calculated sensitivity.

Anti-Cra: family study and survival of chromium-labeled incompatible red cells in a Spanish-American patient.

A 22-year-old Spanish-American woman with juvenile rheumatoid arthritis developed anti-Cra after transfusion during colectomy. No Cra negative family members were found among 13 relatives, including four siblings and both parents. Chromium-labeled red cell survival studies showed a T1/2 of 14 days with Cra positive cells. Two units of Cra positive blood were transfused uneventfully for bleeding after ileorectal anastomosis.