| U.S. hospitals rely upon a safe and reliable blood supply to support more than 30 percent of admissions. When blood of the right type is not available in the proper amount medical procedures can be delayed leading to higher costs and patient risk.; The United States is one of the few industrialized nations without a nationalized blood system. The U.S. system is a patchwork of a few highly centralized organizations and many decentralized, independent blood centers. Attempts to bring these organizations together to create a coordinated system of blood delivery have failed. As a result, the nation's system is fragmented with little, if any cooperation, among competing systems.; Since 1986 the cost of blood and blood products has risen faster than overall hospital operating costs. Further increases in costs are projected as new safety measures are introduced that decrease the available supply of volunteer donors, and increase testing and manufacturing costs.; The purposes of this study were to describe the evolution of blood banking in the United States which has led to the current, patchwork system, to determine the indicators of hospital satisfaction with blood supplier, and to address how organizational structure and strategy affects blood bank performance.; A total of 2,298 blood-utilizing hospitals were included in this study. Hospital blood bank managers completed surveys regarding their level of satisfaction with their blood supplier. Data from the 2000 American Hospital Association (AHA) database were merged with the satisfaction data to add additional information about each hospital and the market in which it operates. Univariate and multivariate analysis were used to answer four main research questions.; The results of these analyses revealed that hospital satisfaction with blood supplier is a latent construct with multiple indicators. Having a representative from the hospital on the blood center's governing board was not significantly associated with satisfaction. A dedicated representative from the blood center to communicate with the hospital on a regular basis was significantly associated with satisfaction as was formalized complaint resolution processes. Centralized systems, with their formal mechanisms of balancing supply and demand were indicated to outperform decentralized centers with regard to meeting hospital's need for blood. Competition and managed care penetration were both negatively associated with satisfaction.; The results of this study have implications for policy makers and blood bank managers. The results suggest that blood center managers can increase hospital satisfaction by adopting strategies to reduce uncertainty and provide a reliable supply of blood and blood products. From a policy perspective, the study indicates that a nationally coordinated blood system as suggested by the National Blood Policy of the 1970's may still be needed in the early 21st century. |
