short term deferral - long term effect! moira carter katherine moir vincent mooney scottish national...
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Short Term Deferral -Long term Effect!
Moira CarterKatherine Moir
Vincent Mooney
Scottish National Blood Transfusion ServiceMay 2009
The Virtual Moira Carter
Not Convinced?
Oh, OK Then!
Let’s be Honest!
Wish I was
there!!
Short Term Deferrals – Long Term Impact on Donor Base
This presentation will aim to explore how true this statement is
Consider what influences our deferral rates Present Research findings on the impacts of Donor
deferrals Consider whether it is possible to refuse a gift well? Explore options for intervention to minimise the long-
term impacts Inspire you to think about how you can minimise
these impacts on Blood Donors and your Blood Centre
Where were we?Donor Deferral Rate Trends
21% increase in new donor deferral rate since 2003-04
24% increase deferral rate overall for donors since 2003-04
Scottish Deferral Rate Trends
0
5
10
15
20
25
30
35
40
1990/91
1991/92
1993/94
1994/95
1995/96
1996/97
1997/98
1998/99
1999/00
2000/01
2001/02
2002/03
2003/04
2004/05
2005/06
2006/07
2007/08
2008/09
% D
on
ors
De
ferr
ed
NewDonors
AllDonorsPDI or
New & Lapsed
Tick Box DHC PTD
Exclusion
BSQR
Where were we?-Donor Base Shortfall
Lowest Number of Donors since records began
Donor Base Shortfall of 10,500 Donors 6% and a decline of 10% since 2004/05
Required increased recruitment or increase in attendance frequency from 1.64 pa to 1.69pa
Active Donors Trend & Prediction
100,000
120,000
140,000
160,000
180,000
200,000
220,000
Impact of Exclusion of Previously Transfused Donors
Cumulative Previously Transfused Donor losses (PTD’s) losses of ~22K donations per annum (9.4% of 2009/10 target )
> 8% of of current Active donor base permanently deferred for this reason
Continuing losses of 1400 donors each year 0.8% of Active Donor Base
Donor Losses Previously Transfused Donors
0
2000
4000
6000
8000
10000
12000
14000
16000
Implementation Year 1 Year 2 Year 3 Year 4 Year 5
Total PTD Donors DeferredNew Deferrals
Deferral Rates: Trends post BSQR
Impact on Deferral Rates: SNBTS
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
% Hb Deferral Deferral Rate Medical Deferral Rate
Pre BSQR
Post BSQR
Difference
Increase in Hb deferral results in the loss of up to 10,700 donations/year 4.2% of supply
Increase in Medical Deferral Rate results in a minimum loss of ~5300 2% of supply
Permanent deferrals increased by 50% since BSQR
BSQR Total loss 6.2% losses
What Affects Deferral Rate? Method of Donor Selection
• Detailed Tick Boxes rather than list of exclusions• Personal Donor Interviews for New & Returning Donors
Stringency of the Selection Criteria• Exclusion of Previously Transfused Donors • Blood Safety & Quality Regulations/ FDA criteria
Quality of Staff training in donor Selection • Regional variations in practice• Historical differences in operational practice• Different staff groups making deferral decisions
Donor Population• Donor Lifestyle Choices • Donor Demographics • Health and deprivation indexes
Differences in these issues must be considered when reviewing benchmarking data
Where/When are Donors Deferred ?
•Donor Call UpSelf Deferral
Less Accurate
•Between DonationsSelf DeferralInaccurate
Resulting from Changes in Circumstances e.g. Travel/
Medication etc
•On SessionMost Accurate
Offers more chance to explain
•Call Centre EnquiryMore ControlledMore accurate
Avoids Deferrals on session
NB: Operation practices vary between services and this can account for some of
the apparent differences
•Post DonationInaccurate reporting
Donors less aware of need to report
Donor Or Patient Safety: Review of Donor Health Check Questionnaire
No Of Questions on
DHCDonor Safety
Donor & patient Safety
% Donor or Combined D/P safety
Patient Safety
% Patient Safety
SNBTS Regular Donors 37 3 7 27% 27 73%SNBTS New & Returning Donors 44 3 9 27% 32 73%NBS Regular Donors 30 6 20% 24 80%NBS New & Returning Donors 33 6 18% 27 82%
Benchmarking Deferrals
SNBTS measure Donor Exclusions at Sessions
When Comparing Data with other services we need to make sure that we are measuring like for like
Need to consider differences in Data Capture and Process
Is it Possible to Refuse a Gift Well? Qualitative Research
Qualitative Research: Caffrey Consultants Conducted July 2007
The objectives of the research were:
1. To establish the reasons why temporarily deferred donors do not return to give blood
2. To gauge how deferred donors felt their deferral was handled and to establish degree of rejection, if any, they experienced
3. To investigate any differences between how longer term and shorter term donors respond to deferral
4. To establish which incentives/triggers would entice donors to attempt to give blood again – specifically to test a range of propositions
Method and Sample
Sample identified and sourced by SNBTS
20 in depth interviews were expertly recruited by Glasgow SNBTS recruiters
4 no-shows3 replacedCurrently deferred donors most difficult to replace like for likeTotal of 19 in depth interviews achieved
Caffrey Consulting conducted the 45 minute long interviews between 10th-25th July 2007 in Inverness and Edinburgh
8 depth interviews Deferred donors who have
not returned after the deferral period
6 depth interviews Deferred donors who are
within the deferral period and are undecided
6 depth interviews Deferred donors who did return after the
deferral period
8 achieved
4 achieved
7 achieved
Results: Deferral Experience: The Deferral Event
SNBTS staff well regarded Very few criticisms of the manner in which deferrals were
handled SNBTS staff were repeatedly referred to in exceptionally
positive light At a topline level deferrals handled in a consistent
manner: Staff described as professional, friendly, reassuring Deferral often described as delivered in a factual, matter
of fact, or professional manner Evidence of some deferrals being offered a leaflet
• Recall of dietary advice in Hb leaflet
They were upset themselves because they were having to refuse people
They were very nice…I wasn’t the only one there were others too
The Deferral Event : One or two criticisms
Most common shortcoming is that SNBTS did not make clear to donor when they could return
Doubt = assumptions that may not be correct • Can cause confusion• Particularly amongst repeat Hb cases who assume 12 months• Also for short term deferrals – e.g. ‘come back when you feel
better’ Some concern expressed over how obvious it was that donor
was being deferred• Particularly New donors – this may just be a perception
An offer of tea / biscuits should always be made when deferred
If I wanted to and if I was able I might want to come back sooner
Post deferral emotions?
Generally a mostly rational reaction to being deferredNo great feeling of rejectionDisappointment prevails
Anger, annoyance and irritation more common amongst Regular donors Particularly for Hb deferrals
where EU regulations / changes were cited
Seen as something that is impeding the donor and is very de-motivating
2 regular donors (males) ‘failed’ the Hb test due to EU regulations and both questioned whether they would ever be able to give blood again
Disappointment seems most acute for New Donors
Relief too for New donors but also embarrassment • And within that, new
donors who had gone with a group of people
• Feeling of being in one door and out the other
Post deferral: Not top of mind for long
Very little navel gazing about deferral At most thought about for the rest of the day
Reminded when encounter SNBTS advertising or media coverage of blood shortage
At these times annoyance at being deferred can emerge amongst some donors e.g. O negative blood type donors who are aware of the utility of their blood
Most common mind-set is to wait to hear from SNBTS re: a return date
The deferral visit: Some lack of understanding
Depth of understanding around reason for deferral differed depending on donor previous experiences
Uncertainty over whether deferral was due to risk to donor’s or patient’s health
Second time Hb deferrals may benefit from more time from SNBTS staff to explain why this has happened again
I think you would have felt happier if you had been a bit more explained
Why did some donors tell us they had not returned?
Of the 8 non-returners 4 were regular and 4 new
Regular donors all cited not being told how long they were deferred for as the main reason for not returning
All claimed that they would definitely be going back once they were told they could – they were simply waiting to be invited1 also suggested that having had a reminder she was not sure whether she was still within the deferral period and had not been able to attend to check this
The New Donors cited not getting round to going back, not knowing when to go back, not having had as much contact from SNBTS as they thought they might, not feeling sufficiently ‘wanted’ by SNBTS
1 returned as a result of being invited to participate in the research (and was deferred again)
How deferral length can influence returning
For some the issue is not whether they return but WHEN they return and how to get them to return sooner to maximise donationsThis is most acute in short deferrals (1 day – c 4 weeks)
Key to an early return is to: Make a Date Try to arrange next visit within the current cycle where possibleEncourage donor to share short term view of deferral
Deferral periods also need to be reinforced at each communication to heighten awareness of return date
Donor typologies – key influence on responses to deferrals
Donors who were deferred on their first visit (or first visit in a number of years)
No frame of reference re: the donor experience and in need of most management
Most likely to feel unmotivated
Passive New = most vulnerable
Donors who have given regularly when the mobile unit has visited place of work
/ local area / when feel like they have been asked to
Opportunistic donors & Deferral something that happens to them
Risk that can get lost in the system due to lack of opportunities to donate
By their nature need more targeted encouragement to return
Donors who have given regularly by actively visiting a donor centre or mobile unit
More likely to actively manage donations / visits to minimise potential deferrals /
maximise potential donations
More likely to return of own volition / with limited encouragement
Potential to further maximise donations through communication
New
Reg Passive
Reg Active
How emotional impact of deferral can affect returning
Feel-g
oo
d facto
r
Something that is the norm for them to doReturning was more of an internal motivation
Intrinsic in their nature to continue to try to givePart of the original motivation for giving
No fundamental reliance on external stimulusHowever the functional reminder card is
invaluableEven donors who were repeatedly deferred,
repeatedly returnedIndefatigable spirit
Regular Donors: Why did they return?
Intervention required to restore emotional
well-being and maintain motivation to donate
Feel g
oo
d facto
r
How emotional impact of deferral can affect returning
New donors enter at a quite high levelAlready feel that they have made a positive decision to give bloodExpecting to give blood and for feel-good to increase as a result
New donors can end up down here when deferredNothing to show for their effort
Effectively like a crashNeed something relatively immediate to get back up the
scale
Desk Top Research: SNBTS
Desk Top Analysis of 565 Donors who had attended during Dec 2005
Two Cohorts compared
283 Donors who had returned to give during next 12 months
282 Donors who had not returned
Donors were selected at random from all donors who had attended during December
Analysis Conducted by Carol Garnett & Lynn Whitelaw
565 Donors Number 283 282
Had Returned
Had Not Returned
283 282Male 62% 42%Female 38% 58%Regular Donors 96% 46%Irregular Donor 3% 30%Lapsed 1% 1%New Donors 0% 23%Deferred @ Last Visit 8% 33%Previous Deferral History 60% 56%Deferred > 1X 32% 18%Donated in other Regions 31% 17%Donated at Regular venue 89% 81%Donate in >1 venue 13% 6%Listed as Off Service 0% 7%
Desk Top Research: Results
?? Regular Active
?? RegularPassive
Qualitative Research: Conclusions
New donors seem most at risk of not returning. Greatest need to be made to feel special
Regular passive donors may return but could be encouraged to return sooner by demonstrating where opportunities exist and encouraging to break the routine
Regular active donors likely to return relatively quickly after deferral period if the know when to come back
Short term deferrals would benefit greatly from an appointment being made on the day of the deferral where practical
Long term deferrals do not need constant reminders, only at critical points
Revise Donor Selection Criteria
Improve Training on Donor Selection Criteria
Improve monitoring system and conduct trend analysis
Implement ‘Sample Only Donation’ and accreditation of Deferred New Donors to reduce impact of deferral and promote ‘Club Membership’
Develop Welcome Pack with Temp Membership Card for On Session Use
Develop Specific Deferred New Donor letters to accompany Donor Card
Extend range of materials for Deferred Donors on Session
Possible Interventions
Possible Interventions
Clearly Identify the date the donor can next donate and identify the next donation opportunity. Provide Donor with written confirmation on day
Develop Intervention Models For New and Regular Donor who have been Deferred
Conduct Further Research on the Characteristics of Regular Passive Donors
Develop an end of deferral mailing or tele-recruitment strategy
End of Deferral Mail shot: Pilot
Why did we do it? • Research indicated donors were unclear on
when to return• Routine Donor Call up did not seem to trigger
return• Therefore, needed to send clear signal
How did we do it?• Limitations of current IT system did not permit
automation • Manual system required to record deferral
end date
What Did we do?• Targeted mailing for next session post
deferral end date • Generic letter reminding donor to return with
session details
GROUP DONORS
TARGETEDRETURNED IN
MONTH %RETURNED
AFTER A YEAR %
CONTROL 1204 280 23% 591 49%
TEST 3489 957 27% 1830 52%
These results indicate a 17% increase in the likelihood of return within one month of deferral end date
7% increase of return within the next year
End of Deferral Mail shot: Pilot: Results
Automation via e-Progesa or Data extraction, Ultimately CRM
More specific to deferral reason
•Pregnancy
•Body Piercing & Tattoo
•Travel –Malaria/Chagas
•Hb
End of deferral telephone call to build relationship
Combined impact of on session improvements and letter/call
End of Deferral Mail shot Pilot: Next Steps
Why did we do it? • Research indicated donors were unclear on when to return• Donors did not share the view that deferral was temporary • No matter what we tell the donors when they are deferred, many do
not take the information on board.• This results in donor complaints or failure to return• To avoid distress / annoyance at being deferred • The “walk of shame” – donors are often in a hurry to leave and
therefore do not listen
How did we do it?• Designed card for on session use
What Did we do?• Conducted pilot for all deferred donors for 1 month • Provided simple written information on whether they can return,
and if so when, or how they will be told – the “Deferral Card• Conducted donor satisfaction survey
Session Deferral Card:Pilot
The On Session Deferral Card
Starts off with a “Thank you”
Session date recorded so donor can relate from this
point.
Tick-boxlist of options
Blood Centre contact number provided
T h e d o s e o f y o u r m e d i c a t i o n … … … … … … … … … … … . . i s s t a b l e ( i . e . h a s n o t b e e n c h a n g e d r e c e n t l y ) .
Y o u n e e d a n A c u p u n c t u r e C e r t i f i c a t e f r o m y o u r P r a c t i t i o n e r – c o n t a c t D o n o r C e n t r e f o r m o r e d e t a i l s .
O t h e r -
B e f o r e y o u c a n d o n a t e : -
A few regular deferral items listed overleaf – otherwise space to record free text.
The On Session Deferral Card
15 7 08
Sample Card: Failed haemoglobin
The Deferral Card – Examples of Use (3)
3
15 7 08
GP investigating upper GI symptoms
The Deferral Card – Examples of Use (9)
T h e d o s e o f y o u r m e d i c a t i o n … … … … … … … … … … … . . i s s t a b l e ( i . e . h a s n o t b e e n c h a n g e d r e c e n t l y ) .
Y o u n e e d a n A c u p u n c t u r e C e r t i f i c a t e f r o m y o u r P r a c t i t i o n e r – c o n t a c t D o n o r C e n t r e f o r m o r e d e t a i l s .
O t h e r -
B e f o r e y o u c a n d o n a t e : -
All investigations must be negative, and you must have no further planned follow up.
One month pilot conducted August 2008
234 Donors Deferred
193 Questionnaires Sent (82% sample)
48% Response Rate 93 responses
100% said they understood the information
97% said they found the information useful
82% thought donors who got a card would be more likely to return
Session Deferral Card:Pilot: Results
13 free text comments of relevance
9 were positive – e.g. “good idea”/ “excellent idea”.
2 were “negative” – “would have returned even if I didn’t receive a card”/ verbal information was good enough.
2 were practical issues – “heavier card”/ “more wallet-sized”
One particularly enthusiastic comment was “Being told when you can donate is a really good idea as opposed to being told to “try again next time”, especially for the first time donors”.
Session Deferral Card:Pilot: Results
Implement nationally alongside Sample Donation
Encourage Donors to visit website to find an alternative donation opportunity for short deferrals
Provide dates of future sessions
Extend the range of deferral information on session
Monitor return rates
Session Deferral Card:Pilot:Next Steps
Other Initiatives
Revised Donor Selection at UK Level• High Blood Pressure Medication• Removed Upper Age limit for regular Donors • Accept non insulin dependent diabetics
Implementation of Capillary Hemocue to improve accuracy of Hb screening
Revise donor selection methods for lapsed donors returning after more than two years
Implemented national training for all donor selection staff
Where are we now?
Deferral Rate
Before (Peak Level)
After (2008/09 average)
% Change
All Donor 20.50% 18.20% -11.2%New Donor 40.40% 34.70% -14.1%
Where are we now?
Decline reversed, rebuild commenced
Active donor: Trend to Year End 2008/09
168000
170000
172000
174000
176000
178000
180000
182000
184000
186000
Apr
-07
May
-07
Jun-
07
Jul-0
7
Aug
-07
Sep
-07
Oct
-07
Nov
-07
Dec
-07
Jan-
08
Feb
-08
Mar
-08
Apr
-08
May
-08
Jun-
08
Jul-0
8
Aug
-08
Sep
-08
Oct
-08
Nov
-08
Dec
-08
Jan-
09
Feb
-09
Mar
-09
5.2% % increase since
Ad Launch
Donor base increased by 6.2% (10,749) since December 2007
Donor attendance frequency has reduced from 1.63 to 1.61
Your Action PlanNo matter what your role is- You can make a
difference to mimimise the impact of Deferrals on Blood Donors and Tour Blood Centre. ACT NOW!
ACTION BY WHEN
BENEFIT TO BLOOD DONORS
OR BLOOD CENTRE
