The 90s paradox: QA efforts reduce total quality

The focus on "closing the window" of infectious risks in transfusion has concentrated limited health care resources on marginal increases in blood safety in the name of quality assurance (QA). Significant investments in testing and medical history additions have been made to restrict further any release of unsuitable blood and apheresis donations. As funds are used in a disproportionate manner with regard to these quality benefits, the depletion of resources precludes investment in quality enhancements (e.g. potency) other than safety, and actually may reduce quality over all. Although safety is an important element of quality, it is not the only element. Increasingly, blood center customers expect, but are unwilling to pay for, limited increases in product safety, such as anti-HCV 3.0 and HIV p24 antigen testing; they should be encouraging improved potency and efficacy for QA. In the future, blood service providers must demonstrate the value of additional QA activities--otherwise, they will not receive reimbursement. Total quality remains the objective goal. However, the investment in QA efforts must yield a benefit equal to, or greater than, investment in the quality assurance process.