Creating a Consolidated Centralized Blood Service Sanquin W

Creating a Consolidated, Centralized Blood Service: Sanquin W Martin Smid Director Academic Institute IDTM Mananging Director SCO 16 March 2018 | 1

OUTLINE OF PRESENTATION • Introduction: Sanquin • History • Consolidation and Centralization • • The Merger Consolidation Uniformity Cost Efficiency • Blood Bank • Blood Supply Management • Reduction in Demand • International Cooperation • Conclusions

Sanquin the Dutch Blood Supply • Sanquin is responsible for supplying blood in The Netherlands on a not-for-profit basis • Sanquin is the only organization licenced in the Netherlands • The hundreds of thousands of donors who give blood on a voluntary basis are the heart of the organization • Core activity: producing and supplying blood and plasma products for treating patients – safely and efficiently 16 March 2018 | 3

Sanquin Organization Executive Board Corporate staff Blood Bank Plasma Products Diagnostic Services Research Reagents Pharmaceutic al Services 16 March 2018 | 4

Key figures 2013 (1) 16 March 2018 | 5

History 1901 Karl Landsteiner discovers ABO blood groups 1914 Discovery of principle of anticoagulation 1923 First civil blood transfusion service founded in London 1925 First donor service founded in Rotterdam 1900 - 1925 1926 - 1950 1959 CLB moves to Plesmanlaan 1960 First new-style blood bank founded in Rotterdam 1962 Law on human blood accepted 1964 Cryoprecipitate is discovered 1972 Freeze-dried factor VIII 1973 Plan for 25 blood banks 1975 Newly built fractionation plant in Amsterdam 1951 - 1975 1930 Dutch Red Cross blood transfusion service founded 1937 Rhesus blood group system discovered 1943 Anticoagulation methods discovered 1940 Fractionation set up in Amsterdam and Rotterdam 1944 Freeze-dried plasma 1949 Cohn fractionation 1946 CLB founded, mobile blood collection campaigns 1976 - present 1988 Law on blood transfusion 1992 New plasma factory CLB 1998 Collaboration with CAF 1998 22 blood banks and CLB merge to form Sanquin 2000 Law on blood supply 2006 9 blood banks reduced to 4 2010 One Blood Bank 16 March 2018 | 6

Cause for merger and centralization • Investigation by the Ombudsman initiated by complaints of hemophilia patients about government action against HIV infection(1980 -1985) • 1995 Report of Ombudsman published • Conclusion: no wrong doing of Central Laboratory and 22 red cross blood banks • Necessary actions were taken by the players • Government oversight too complicated with 23 independent players • Need for transparency of oversight and inspection • Government would benefit from centralization

Influencing situational factors • Positive: • The idea of standard quality of products and the need for quality assurance • The acting Minister of health had a back ground in blood bank and central laboratory • Centralization was a clear trend within government • • Negative: Central laboratory and blood banks were different worlds Much fear for effects on donor relations Consequences for co-workers

The start • Merger of central laboratory and 22 independent blood banks • Process directed by the Ministry of Health • After two years of preparation Sanquin was founded on January 1 st 1998 • New name introduced at that time. • Former entities all entered lock stock and barrel in the new structure

1997 Signing at Mo. H

Consolidation in steps • 1998 start of Sanquin • 22 Blood Banks transformed to 9 Blood Bank Divisions • • Process in regions had already started from 1996 Gradually and bottom up Continuity and safety were main New building for regional headquarters • Central Laboratory transformed in three divisions • Plasma fractionation, Diagnostics and Research • Plasma division had started international collaboration with CAF

Next step to more uniformity • 2006 a second Consolidation Step • From 9 to 4 blood bank divisions • Reasoning: more uniform products and processes and more economic • Improvement based on best practices • Process approach bottom up with working parties of experts • Discussion centered around 2, 3 or 4 divisions • Limited financial advantage and 4 considered more reliable than 2 • Advantages of centralized screening laboratory were obvious and NSS (National Screening laboratory Sanquin) is implemented • Delivery of test tubes in the evening and testing at night • Further cost efficiency through central purchasing

And then the need for more efficiency • Consolidation to a centralized national blood bank in 2010 • Reasoning: cost efficiency and guarantee of quality with uniform products and processes combined with central purchasing • Four division become one centralized blood supply • Process approach had changed to top down • Organizational model changes from division model to centralized organization with four Units • Donor affairs, Processing, Transfusion Medicine, Quality Assurance

Executive Board/Director IC-BB Secretariat Donor Affairs Release management Consulting Services Production IC-BB=Information Centre Blood Bank, P/I/C = Processing/Issue/Customer service, DTM= Department of Transfusion Medicine, QA/RA=quality assurance, regulatory affairs DTM/ Medical affairs QA and RA 16 March 2018 | 14

A Centralized Consolidated Blood Supply • Donor Management and Collection • 3 Regions for Mobile Collections • Centralized Donor Management • Processing • 2 Locations • 11 distribution centers: based on mathematic model for delivery of Hospitals • Transfusion Medicine • 4 regions near the hospitals with “bridge” specialists • Quality Assurance and Control • At the Two Processing Locations • National Screening Laboratory (Sanquin Diagnostics)

Blood Supply Management • Developing from 2010 (EBA, Council of Europe, ISBT, Australia) • In essence provide sufficient and safe blood for patients in need in a cost efficient way with minimal discard • Combination of Donor management and production logistics • DOnor MANagement IN Europe (DOMAINE) • Mathematical model for stock management • Challenge: demand for blood in the Netherlands is decreasing the collection amounts to 27/1000 whole blood donations last year

The logistics of blood supply in The Netherlands 16 March 2018 | 17

Delivery of blood at all times • According to the Dutch Transfusion Law • Sanquin provides the blood as needed by Hospitals • Includes the blood groups as requested • Distribution is supported by Unit Transfusion Medicine • Includes delivery by Sanquin of the blood product to the hospitals • For emergency “ 1 hour criterion” • All blood types

Blood Supply Management RBC use 448, 488 Platelets (donor units) 264, 906 Fresh frozen plasma 67, 071 Kilograms plasma total (incl. apheresis) supplied to Plasma P division 308, 895

Education and advice • Sanquin provides education and training • Sanquin participates in education programs of higher vocational colleges and universities, including the training courses for medical specialists and courses for blood transfusion physicians and specialists • Sanquin provides specialized courses and refresher courses for professionals in the medical world • Consultancy is focused on knowledge transfer to low and medium income countries 16 March 2018 | 20

International cooperation • For a national blood supply organization peers are in an international field • Especially in Europe: same EU guideline is applicable • International Cooperation: • • • The Sanquin Blood Bank of Frozen Blood supplies units of rare blood types Surpluses and ad hoc collection for international (emergency) aid and UN International reference function • Following the consolidation in plasma fractionation • In the field of International Blood Safety • Partnerships with organizations abroad and the Dutch Red Cross:

Sanquin and International Blood Safety • Sanquin Consulting Services • Mission Statement • Activities since 2010: • Projects: Uganda and Zambia (PEPf. AR no cost extension), Pakistan (GIZ) Turkey (EU funded), Curacao, Sri Lanka (Government of SL), Suriname (UTSN Twinning), Montenegro (WHO: EU funded) • Internships • International cooperation: • In projects and otherwise: e. g. WHO, Af. SBT, ISBT, AABB, Red Cross Blood Bank Curacao, UTSN, GFA, Simed, IBSF, IDTM

Sanquin and IDTM • Academic Institute for International Development of Transfusion Medicine • Collaboration of Sanquin and University of Groningen and University Medical Center Groningen • Offers a Master in Management of Transfusion Medicine at the Graduate School of Medical Sciences of the University Medical Centre Groningen • Sanquin Provides the Internship during the second year • Two year master program: 1 st year distant e-learning, 2 nd year internship

Haemovigilance in the Netherlands • Named TRIP: Transfusion Reactions In Patients • Collaboration of most stakeholders in the blood transfusion chain • Administration and additional investigation by questions asked • Reporting by hospitals is Web based with additional possibility to forward also to the Inspectorate of Health and/or Sanquin • Yearly report: www. trip. nl

Plasma Products division • The Sanquin Plasma Products division produces 11 types of medicines from plasma; coagulation factors, protease inhibitors, immune globulins and albumin • The Sanquin Plasma Products division co-operates closely with sister organizations abroad, like the Belgian CAF-DCF, the Finnish Red Cross Blood Transfusion Service and the French LFB • Collaboration based on economies of scale and efficiency • Production facilities in Amsterdam and Brussels • Very recently separated financially to minimize the risks for the public blood bank part (to contain possible financial risks for Blood Bank) 16 March 2018 | 25

In conclusion • Sanquin is the Dutch Blood Supply on a non profit basis • Stepwise consolidation and centralization during two decades resulted in a National blood supply; combining quality, research, efficiency. • Challenges are the ever decreasing demand of RBC and financial restrictions and risks • International cooperation with peers in order to be able to continue to improve and to share • Knowledge transfer in cooperation with low and medium countries

Name and logo • Sanquin is a reference to the French (le sang) and Latin (sanguis) words for blood • The logo is based on a centuries-old legend • The mother pelican feeds her hungry young with her own blood to save their lives • This is why it has become a symbol of altruism and compassion • Blood from donors saves the lives of many patients 16 March 2018 | 28

Ambitions Sanquin possesses a rich history and has deep roots in Dutch society. Based on this strong foundation, Sanquin wants to: • Expand its international activities • Continue to focus on quality and innovation • Conduct research and share knowledge to advance transfusion medicine nationally and internationally • Continue to focus on the donor Without donors, the blood supply service in The Netherlands would not exist. Sanquin is fully aware of this, every day. 16 March 2018 | 29