Lucy Marowa and Chancellor Kafere;
The trend in business nowadays is for com­panies to improve their performance and market leadership through improving the quality of products and services.

Health institutions, including blood serv­ices, are not an exception and many have begun to implement quality management systems (QMS) as a means of improving practices and service delivery. In line with this, National Blood Service Zim­babwe (NBSZ) prioritises quality manage­ment in all processes and implements formal quality management sys­tems. Although NBSZ is a not-for-profit company, one might ask why the organisa­tion bothers about qual­ity sys­tems yet the consumers of its products do not have direct say/choice/influence over the products that they get. This article delves into the impor­tance of quality and the strate­gic role it has played in the organisation.

Quality in NBSZ
Quality in blood transfusion is concerned with every aspect of the transfusion practice and applies to all its activities. The scope of activities in the local blood service includes identification and selection of prospective blood donors; adequate collection of blood; preparation of various blood components from the collected blood units; laboratory testing as well as ensuring safest and most appropriate use of blood components.

This is best achieved by having a dedicated quality department within the blood service which is responsible for the development, implemen­tation and maintenance of a QMS among other things.
At the NBSZ, the Safety, Health, Environ­ment and Quality (SHEQ) department is responsible for co-ordinating issues to do with quality and occupational health and safety throughout the organisation.
The NBSZ’s QMS is based on the ISO 9001:2008 and ISO 15189:2007 standards. ISO 9001:2008 is a generic standard to which any organisation can be certified, whilst ISO 15189 is specific for medical testing laborato­ries and is com­petence based.

How quality is achieved at NBSZ
There are numerous processes and activi­ties that are done as part of managing the quality system. Some of them are as follows:
Document control — Documents are fun­damental to the existence and effectiveness of the QMS. The NBSZ documents are con­trolled such that their creation, approval, dis­tribution, use and archiving is done in a sys­tematic manner. This ensures data is man­aged well in a secure environment thus pre­venting unauthorised access.

Incoming goods inspection — This process is a measure to ensure that only suit­able inputs are brought into the blood service. The SHEQ department inspects and evalu­ates all critical incoming goods such as labo­ratory testing reagents, blood bags and machinery, among others. This process is of paramount importance as these inputs have a direct impact on the quality of blood issued out by the BTS.
Quality control (QC) — is performed at var­ious stages of the production processes, spanning from pre-processing, in-process and post-processing stages. This includes QC of blood and blood products that are made from the units of blood that are collected from the donors to that the resultant prod­ucts have the required characteristics needed to benefit the patient (product efficacy).

Internal quality audits — The NBSZ imple­ments a comprehensive internal audit pro­gramme to verify whether the quality sys­tem and operational processes are adequately implemented, are effective and comply with the requirements of the applicable national and international standards.

The audits are conducted by individuals trained on the requirements and auditing of the applicable standards and certified compe­tent. Internal and external audits serve as platforms for identifying weaknesses and areas of improve­ment within the organisation so that these can be continually improved upon.
Handling of errors — Errors and other forms of non-conformance can occur in the blood bank and a way of handling these has been defined. The NBSZ has a documented procedure for implementing corrective actions which provides for the detection, classification, management and investigation of the non-conformances. Once identified the non-conformance is thoroughly investi­gated to find the root cause so that a perma­nent or lasting solution can be implemented. Related to this is the preventive action process which is similar to the corrective action in most respects but only differs in that it is implemented to eliminate a potential cause of non-conformity to prevent it before it occurs.

Management review of the QMS — is done at least biannually to discuss the func­tioning of the quality system and to take action to correct it when necessary. This meeting dis­cusses, among other things, the review of cor­rective actions arising from pre­vious meet­ings, results of audits, external and internal factors that could affect the QMS, process performance information and rec­ommendations for improvement.

Occupational safety, health and environ­mental (SHE) system — is in place to protect the workers and visitors from the hazards associated with our operations.
Clear rules for healthy and safe work behaviour have been stated and all staff made aware of them. Blood is potentially infectious as it can contain various infectious agents thus NBSZ strives to safeguard staff, donors and the general population from exposure to dangerous organisms encountered in its operations as well as to comply with applica­ble local environmental laws and regulations.

Cost implications and benefits of quality
Quality management is associated with some costs right from the implementation of the QMS and throughout the whole period it is maintained. It introduces costs such as in the purchase of new equipment, maintenance of equipment, quality control testing costs and training costs, among others. Maintain­ing these improved activities also costs money which the NBSZ has to budget for during each financial year.

These costs are, however, outweighed by the benefits of a successful QMS. The NBSZ is testimony to this as it is enjoying the bene­fits since it introduced the QMS based on the ISO 9001:2000 to which it was successfully certified between 2007 and 2010 and which is currently being improved upon by the efforts to gain ISO 15189 accreditation in addition to ISO 9001:2008. Some of the benefits that have been enjoyed by the organisation are as fol­lows:
i. There has been a marked improvement in the quality of products offered to patients.
ii. The failure costs were also reduced which were very high due to system ineffi­ciencies. Due to the nature of our products, there is no option for re-work once wrongly done and the products in question would have to be discarded.
iii. There has been optimisation of work flow which results in greater efficiency of processes.
iv. Equipment downtime has been improved due to the existence of a mainte­nance and calibration programme which proac­tively manages optimal performance of equipment.
v. Improvement in internal customer-sup­plier relationships among departments. Each division within the NBSZ has become aware that they do not work in isolation but are there to serve other units and to be served in turn.
vi. Training of personnel has resulted in a more competent and motivated work force that knows their purpose in the company and the impact of poor service delivery.
vii. Regional and international recognition in the field of blood transfusion e.g.
a. NBSZ is a founding member of the Africa Society for Blood Transfusion where it held the post of Secretary General over the past three years. NBSZ also manages the AfSBT website (www.afsbt.org ).

Through the AfSBT, the organisation landed the role of Research coordination which led to the successful launching of the T-REC project (www.t-rec.eu ) which aims at building sustainable capacity for health research in Africa. Zimbabwe together with Ghana are the two beneficiaries of the EU Research funded project.
b. Was previously designated as a World Health Organisation (WHO) collaborating centre for training in 1994 until the national economic meltdown in 2008/9. This status is being resuscitated presently owing to the eco­nomic stability. The NBSZ CEO is a member of the WHO expert panel on blood transfu­sion and has produced two training manuals on blood cold chain.

c. Some staff members from NBSZ provide consultancy services to African countries on behalf of the AABB (formerly American Association of Blood Banks) and these peo­ple are highly respected in Africa.
d. NBSZ is a member of the International Society for Blood Transfusion, the premier international professional society for the field encompassing transfusion and transplanta­tion science and medicine.
NBSZ has contributed to the ISBT through scientific papers at its various annual con­gresses thereby making its mark internation­ally.
The implementation and maintenance of quality systems has definitely cost NBSZ some money and there will always be costs associated with this.

Nevertheless, these costs are much lower than what we would be losing out had we not chosen this route. At NBSZ, we believe in the saying of some famous person who stated that “Quality costs, but poor quality costs more.”

• For your questions and answers please write or contact: Esther Massundah, Public Affairs Manager, on 707801-4, mobile 0712612829 or email emassundah@blood­bank.co.zw