United Nations Public Service Awards Case Studies

The Problem

Australia spends approximately 0.73% of the national health budget in providing fresh blood, plasma and recombinant blood products. These are key elements in the ongoing and emergency health care requirements for many citizens. In 2001 a Review of the Australian blood sector identified that major changes were needed if Australia was to enjoy reliable access to a safe, affordable and appropriate supply of blood products into the future.

The Review identified a number of major problems with the provision of blood products in Australia, including a fragmented approach to supply planning and management (including procurement) and poor national priority setting. A major concern was that access by citizens’ to treatment had occasionally been disrupted through supply shortfalls. Underpinning these problems was a lack of clarity in responsibilities and accountability between layers of government at a national and regional level. There was also expensive and unnecessary duplication of arrangements for the supply of products. Opportunities for improvement were also identified in risk management, safety and quality assurance, appropriate use, efficiency and achieving better value for money.

The Review resulted in a decision by the Federal and eight State and Territory governments to create a new statutory body, the National Blood Authority (NBA). The NBA was established in 2003 to undertake planning and management responsibility for the Australian blood sector and has operated successfully with 35-48 staff members since this time.

The challenge was to create the NBA as a small expert body that could improve the delivery of blood related health services to all citizens as well as providing improved contemporary knowledge on blood issues to government. It was clearly critical to understand the core capabilities required to perform its functions. Hence, an initial assessment of core capability requirements was conducted. This highlighted the need to:
• Understand the market dynamics and commercial imperatives within the global plasma products industry;
• Understand the risk environment and the particular challenges facing the delivery of fresh blood products by a not-for-profit organisation; and
• Develop sufficient networks and clinical knowledge to effectively engage the clinical community in developing strategies to improve blood usage.

The NBA has therefore needed to use its scarce resources to obtain relevant specialized knowledge, retain and access that knowledge, and have appropriately skilled staff.

To achieve this, the NBA has built a sustainable private and civil knowledge network which has supported and enabled acquisition of information in a cost effective manner. This knowledge network needed:
• To withstand internal staff changes;
• To address the paucity of readily accessible information in the public domain, particularly around the plasma industry; and
• To be supported by organisational capabilities in key areas.

What is the initiative about? (the solution)
Our network has resulted in benefits to citizens through a more secure supply of high quality blood products, better value for money, and a focus on appropriate use of products. Firstly, the NBA has maintained an adequate supply of blood, plasma and recombinant products to meet 100% of identified clinical need since 2003. There has been no recurrence of the previous supply shortfalls. We believe this is a direct benefit of our knowledge network initiative. Secondly, the establishment of our knowledge network has enabled us to develop more robust risk analysis and risk mitigation strategies, since they are based on an in-depth understanding of how products are used, the supply chain, and product production. One example of a key achievement which has improved health security and which has benefited from the knowledge network, is the National Blood Supply Contingency Plan (NBSCP). The Plan was developed through dialogue with all jurisdictions and has been distributed to every Australian hospital. This plan is integrated with the risk plans of private and not-for-profit suppliers and provides essential information to allow management of a risk event at a national level. The NBSCP won the National Prize for Risk Management Initiatives awarded by the Commonwealth Government in 2009. The NBSCP was activated in October 2008 in response to a domestic shortage of red cells. Measures undertaken in accordance with the Plan ensured there were no disruptions to clinical practice. Consultation frameworks, inventory analysis and other mechanisms developed for the Plan are also used to monitor the impact of any international or national catastrophe on blood demand and take actions to reduce the possibility of the plan’s formal activation. These were effectively tested in response to a number of emergencies in 2009, such as the Victorian bush fire disaster, the tsunami in Samoa, earthquakes in Sumatra, and the H1N1 (pandemic) outbreak. Thirdly, the knowledge network initiative has allowed the NBA to negotiate contracts for better quality and safer plasma and recombinant products at lower prices than the arrangements prior to 2003. We estimated that this has saved governments around $16 m per annum. This is despite global prices rising significantly over this period of time. Fourthly, the network enables the NBA to drive an increased commitment to improving the clinical use of products. The NBA has overseen the production of evidence-based clinical guidelines for: the use of Factor Eight (FVIII) and Factor Nine (FIX) in haemophilia; intravenous immunoglobulin (IVIg); and RhD immunoglobulin in at risk pregnancies. Improved cooperation with the private and public health sector by the NBA has also led to the production of Australia’s first haemovigilance report in 2008. This report obtained consensus on measures available to hospitals to reduce adverse events from the use of blood products. These benefits have been acknowledged by an independent government review. The Review’s report stated “In its short period of existence the NBA has been conspicuously successful in ensuring greater value for governments.”

Who proposed the solution, who implemented it and who were the stakeholders?
The knowledge network was proposed by management and implemented by all staff. In 2003, the Federal Department of Health and Ageing engaged a private consultant to support the NBA in its first major commercial blood supply negotiations. This consultancy identified the NBA was in a fundamentally weak commercial position and recommended that the NBA strengthen its position by building an intelligence data base and knowledge network. NBA management accepted this finding and made a concerted effort to rapidly establish an effective network. Initially information was obtained through the consultancy and supplemented by purchased reports. The General Manager then embarked on a program of visits to major international blood fractionators. The knowledge acquired was captured in comprehensive reports and established the NBA’s initial knowledge platform. However, purchasing advice did not offer a cost-effective solution to address the NBA’s ongoing knowledge requirements. At the same time, management commenced building the organisation’s capabilities through extensive dialogue with all staff and the development of formal procedures. Key Business Processes (KBPs) were developed for our key internal functions. These captured compliance requirements and allowed acquired knowledge to be incorporated into operational activities. Ownership of these KBPs was shared by senior and middle level managerial staff. In 2007, the knowledge network and capability strategies evolved into a comprehensive corporate capability strategy under the guidance of the NBA’s Advisory Board. We identified potential improvements to enhance knowledge flows and organisational capability and selected initiatives on the basis of staff estimates of their effectiveness and ease of implementation. Staff also participated in two surveys (2006 and 2008) to identify the skills and expertise needed in the NBA and our current level of expertise. The gaps between needs and current capabilities guided an integrated knowledge, training and recruitment program. Specific training/skill requirements are now discussed and agreed between staff and management and reflected in individual training and development programs. One of the core objectives of our knowledge network is to ensure that contributions reflect the broad range of expertise and views of citizens, as well as relevant public sector institutions. The NBA’s private knowledge network partners include the domestic private hospital and pathology sector, product suppliers, international plasma manufacturers, and business analysts advising the investment industry. Our clinical network partners include local and international professional organisations, clinicians, nurses, patient representative groups and the Australian Red Cross Blood Service. Our international government networks extend into Europe, Asia, Canada, USA and South America. Where appropriate, these alliances have evolved into formal relationships such as expert advisory committees, appointment as NBA Fellows, and involvement in key processes such as blood product tender evaluation committees. In summary, the development and implementation of our knowledge network has been an excellent example of success achieved through engagement and empowerment of senior management, strategic advice from the NBA Advisory Board, dialogue with and operational advice from staff, and support from domestic and international partners.

Describe how and when the initiative was implemented by answering these questions
a. What were the strategies used to implement the initiative? In no more than 500 words, provide a summary of the main objectives and strategies of the initiative, how they were established and by whom.
The goal of the initiative was ‘to build and maintain organisational capabilities so we can consistently perform at a high standard’. The primary objective was to develop the ability to efficiently acquire and utilise knowledge that already existed in the private and civil sectors in a cost effective way. We identified five capabilities that we needed to support knowledge acquisition: business systems and processes; performance management; stakeholder engagement; staff commitment; and organisational development. Senior Management assumed ownership of these capabilities and worked with staff to improve performance. A second strategy to initiate knowledge flow was to develop private and civil knowledge networks by forming alliances with people working in relevant areas. Our risk analysis demonstrated that relying on only a few sources of information was high risk, and so we mitigated this by developing an extensive network with multiple sources of knowledge from the clinical, government, private and not-for-profit sectors. Private sector network participants include both current and potential product suppliers. Where we have contractual arrangements with suppliers, it is now a requirement of the contract that suppliers provide regular briefings to staff on industry and sector developments. These are included as part of our fortnightly Knowledge Management Forums which are open to all staff. A third strategy, to ensure that information acquired is validated and robustly interpreted was to appoint a retired academic as our intelligence officer (IO). A key objective of the IO is to help the NBA to develop expertise in the plasma industry by providing detailed information on technical, industry, and clinical developments that may be relevant. Our IO performs horizon scanning by conducting web searches of company announcements, medical journals, financial markets and a range of other information sources. To facilitate this objective, a steady flow of information on developments is distributed to relevant staff frequently; and summary reports are compiled every two months for our advisory and governance boards. As few countries undertake blood and plasma management at a national level, in 2007 the NBA created a small international network of countries engaged in the purchasing and/or planning for plasma and recombinant blood products. This improved our flow of international knowledge of the global plasma industry, by providing a forum for dialogue on policy development, technological advances and product usage, pricing and availability. This collaboration meets annually to share knowledge, benchmark performance and to discuss emerging issues. Finally, the NBA has developed a number of internal systems to support knowledge management, to augment the KBPs for our core functions. A detailed and fully integrated intranet system provides ready access to the KBP’s and other critical documentation. A search engine has also been implemented to allow easier retrieval of stored knowledge and improvements to this system are assessed on an ongoing basis.

b. What were the key development and implementation steps and the chronology? No more than 500 words
The development of our knowledge network commenced in the first six months after the NBA was established and grew as a result of risk management planning. The network initially included organisations and individuals that were formally linked to the NBA though governance or contractual arrangements but extended rapidly to include potential suppliers, overseas agencies, health professionals and the broader Australian community. The development of organisational capabilities to support our knowledge network followed a less structured approach initially but evolved into a formal capability strategy in 2007. The development of this formal strategy was based on research into organisational capabilities conducted at the Australian Graduate School of Management (Turner and Crawford,1998), an evaluation of progress that had been made to date, staff surveys on required skills and expertise and dialogue with a specialist consultant. From this analysis, six key capabilities were identified as crucial to the ability of the NBA to deliver successful outcomes for citizens and governments. These included: • Consolidating the quality and volume of knowledge available to the NBA through its knowledge network; • Ensuring staff are able to apply processes and knowledge; • Enhancing our engagement with citizens; • Increasing the capacity to adapt and develop the organization; • Refining business systems and processes; and • Improving our capacity to manage and measure performance. To improve our capabilities and progress the knowledge network, we selected ten actions for implementation, based on advice from our Advisory Board and staff. Each of these actions was assigned to a different staff member for implementation. As ease of implementation was a selection criterion, some actions required little effort to implement and had the added advantage of providing a sense of achievement for staff. For example, formalizing and executing the obligations of suppliers to provide us with knowledge, was achieved with a formal written request and follow up phone calls. Other actions, such as a re-evaluation of our stakeholder engagement strategy, required extensive dialogue and consultation across and outside the organization and the development of a new KBP. The work required to maintain our private and civic knowledge network and our organisational capabilities is now embedded within our formal corporate and operational plans. Actions required by individuals are included in their individual performance agreements and supplier’s obligations are included in their supply contracts. A formalised induction program for new staff requires familiarisation with our knowledge network and includes the processes and policies for utilising the network in their daily tasks.

c. What were the main obstacles encountered? How were they overcome? No more than 500 words
A major obstacle to implementing our knowledge network was the size of our organisation. As a small government agency with a high workload and few resources, there was limited staff capacity and no possibility to hire extra staff. One way that the NBA addressed this was to ensure that knowledge management expectations formed a core element of our recruitment and induction processes. We have also provided staff with the time and resources to undergo training and acquire knowledge. Monthly performance reporting, both internally and to our Advisory Board, measures training commitment. Perhaps the most challenging obstacle, however, was to create a culture that values knowledge management and acknowledges staff performance in this area. This requires staff to develop work practices and relationships that foster and support this principle. The diversity of the employment backgrounds of our staff adds further complexity to this requirement as many have previously worked in environments significantly different to ours. The NBA addressed this issue by making it easy for staff to access and use knowledge. Sponsorship of the initiative by management and the inclusion of performance measures for key initiatives in the NBA’s regular scorecard report also assisted in retaining our focus and effort. The NBA’s subsequent success, and external recognition by stakeholders, reinforced application of the approach and helped embed the cultural change. Developing a culture of reliance on the flows of private and civic knowledge also created new risks. These were mitigated by: • Establishing procedures around the management of conflict of interest and information confidentiality; • Fostering an open and collaborative information environment within the NBA compared to a ‘need to know’ environment; and • Ensuring that storage of all information was robust and could be shared by all staff. This was undertaken in accordance with the requirements of the Australian Archives and we remain one of the few agencies to have attained full compliance with these stringent requirements. The volume of “open information” that became available to us does present its own challenges. One obstacle that we encountered was that our initial efforts to develop a centralised, structured IT repository of knowledge were unsuccessful. Staff found it difficult to locate relevant knowledge or, at times, to be aware of its existence. Our solution has been to expose relevant staff to knowledge as it enters the network and then to support information retrieval via a user-friendly IT search tool. We believe that our knowledge network allows us to improve performance in the health sector generally, and hence an ongoing project remains the need to improve the effectiveness of our information retrieval. We have scoped the implementation of a fully integrated electronic records and document management system and will further explore the cost effectiveness of this in 2010.

d. What resources were used for the initiative and what were its key benefits? In no more than 500 words, specify what were the financial, technical and human resources’ costs associated with this initiative. Describe how resources were mobilized
The NBA has implemented this initiative within existing resources. The benefits of the knowledge network were recognised early and the processes for enabling the network were developed as the NBA was being established. Implementing the network early had the added advantage of not requiring additional resources or having to undergo change management at a later date. As part of the initiative, we have assessed and researched the potential to utilise existing resources and materials from other agencies. Maximum utilisation has also been made of existing information technology, including a centrally managed secure on-line portal capability. The portal has enabled us to establish a number of on-line government and clinical communities to share information for meetings and developmental projects. We believe it has helped to strengthen the health system by allowing the NBA to both disseminate data and receive useful information via secure access. For example, in the event of a risk to the blood supply information is easily shared with relevant stakeholders thus fostering health security. Since the processes and procedures have been well embedded, we have found that our private and civil knowledge network requires minimal effort and resources to maintain. Most participants, such as suppliers, industry analysts and clinical experts are keen to freely participate in a system which contributes to improving the health sector. Internal information flows and information-sharing between staff, both formally and informally, are encouraged. The only resources specifically dedicated to the initiative in the last three years are an information officer and an IT search tool. In addition, staff from the NBA have undertaken international travel to attend conferences, visit manufacturing facilities and hold meet with other blood services. The knowledge gained from these visits is formally incorporated into the network. The NBA is grateful for the knowledge that flows into our network. We find that many citizens are highly motivated to contribute to the work of the NBA and the NBA is very responsive to their inputs. The difference that the NBA work has made to the health sector is visible and we are confident that “making a difference” is a motivator for both staff and our external knowledge partners.

Is the initiative sustainable and transferable?
The knowledge network is both sustainable and transferable. Sustainability is maintained by ensuring that well developed processes and policies provide a framework for the knowledge network. For example, there are processes that ensure that key knowledge is embedded within our KBPs. Our KBPs provide comprehensive guidance on performing the most important organisational functions. The KBPs are updated as new knowledge is gained via the network. Reliance on only a small number of knowledge sources was considered high risk and the network ensures we have multiple sources of information and utilises robust validation methods. Sharing knowledge is now the routine way in which the NBA does business. A fortnightly staff knowledge forum provides access to both internal and external experts who present on different elements of the blood sector. It is also a requirement of all blood product contracts that suppliers provide an annual presentation to staff of the state of their industry and blood sector developments. Information from these forums is an essential part of the network. Both the structure and content of the knowledge network is transferable. The NBA has deliberately created structures and means to share the knowledge we gain with persons external to the organisation. This also facilitates ongoing two-way communication. For example, we provide a bi-monthly horizon scanning report to each government member of our governance committee and receive valuable information in return. We also provide comprehensive information on our web site, including public versions of final contracts. We know from feedback that this information is accessed by international organisations in addition to domestic ones, e.g. United States Environmental Protection Agency. The NBA’s success in the Prime Ministers award for Excellence in Australian Public Sector Management in 2007 and the Comcover award for Risk Management (Highly commended 2007, overall winner 2009) have also provided opportunities to promote our knowledge initiative. A number of successful projects, such as our business continuity plan, have been used as examples of best practice across the Commonwealth Government and we have regularly been approached to advise other agencies on the establishment and overall governance challenges of a small agency. In 2009 the NBA created the international collaboration of National Plasma Products Supply Planners (NPPSpa). This group of five countries was formed to exchange information on plasma products and the plasma sector so each might benefit from the knowledge of each other. NPPSPa extends, in a more formal and sustainable way, bilateral exchanges that the NBA had undertaken in previous years. The collaboration has enhanced partnerships between countries with similar blood sector arrangements and the knowledge from the NPPSPa interactions is incorporated into the NBA’s knowledge network framework.

What are the impact of your initiative and the lessons learned?
Our knowledge network has allowed the NBA to deliver high quality results for governments while addressing the concerns of the clinical community and the needs of citizens. By harnessing the power of information, the NBA is able to achieve a safe, affordable and secure supply of blood products, provided free to all citizens. Key to this success is a commitment to respect and mobilise the knowledge already available in the private and civil sectors. We are also genuinely interested in dialogue and consultation with our stakeholders and the broader community. Finally, by firmly embedding our knowledge network in the culture of the organisation, the NBA is able to practically utilise the knowledge to inform our activities and achieve our goals. Vital to the success of our initiative was involving our private and civil stakeholders in our activities. This principle is employed across the spectrum of activities ranging from purchasing to policy. For example, our blood purchasing activity is informed by the input from citizens, clinicians, suppliers and governments. Representatives from these stakeholder groups participate further in the evaluation of tenders. In a similar way, NBA activities aimed at influencing clinical practice follow project plans which are informed by clinical representatives, conducted under the auspices of expert clinical groups or professional organisations, chaired by representatives from clinical groups and include public consultation on proposed reports and guidelines. Community participation enhances our network and encourages an open dialogue between government and citizens. A major lesson learned is that knowledge management requires a clear and consistent vision and strong leadership and commitment. As staff are vital to the success of this initiative, ensuring that well developed processes and policies are reflected in induction and ongoing staff training is very important. Adopting an innovative approach to recruitment, which enables us to target staff interested in working in an environment that expects a collaborative and open approach to the capture of information and knowledge, was also a key lesson learned. An example of this is the policy to target the growing number of retirees interested in part time or project based work. These staff bring a wealth of experience and maturity to the workplace and provide sound role models for new staff, from which the NBA has benefited through our knowledge network initiative. Finally, to have successful knowledge management that is transferable and sustainable, one needs to have internal processes and systems that support an open and collaborative approach to information access and management. This approach is only possible if there is an open dialogue with staff which addresses the management issues such as: the conflict of interests, privacy and confidentiality. Embedding the knowledge network initiative into the culture of the organisation ensures that its benefits are continued as the work of the organisation continues and changes over time.


Institution Name:		National Blood Authority
Institution Type:		Government Agency
Contact Person:		Alison Turner
Title:		General Manager
Telephone/ Fax:		612 6211 8301
Institution's / Project's Website:		612 6211 8330
E-mail:		alison.turner@nba.gov.au
Address:		19-23 Moore Street
Postal Code:		2612
City:		Turner
State/Province:		Australian Capital Territory
Country:		Australia

The Problem

Solution and Key Benefits

Actors and Stakeholders

(a) Strategies

(b) Implementation

(c) Overcoming Obstacles

(d) Use of Resources

Sustainability and Transferability

Lessons Learned

Contact Information