The Valadares initiative on patient blood management in Portugal: Accelerating implementation in line with WHO guidance

BACKGROUND: Patient blood management (PBM) is an evidence-based, patient-centred standard of care that improves clinical outcomes. In Portugal, national modelling by the Anaemia Working Group Portugal (2017) estimated that comprehensive PBM implementation could benefit about 384 000 patients and reduce red blood cell transfusions by 51.2% within the first year. Despite a supportive legislative framework established in 2018, implementation has remained inconsistent and below expectations. The World Health Organisation's Implementation Guidance (2025) calls for decisive action, highlighting the need for renewed governance, structured education, and coordinated national efforts to translate policy into practice. METHODS: A multidisciplinary expert panel of national and international PBM leaders met at the Local Health Unit of Gaia-Espinho (ULSGE). Drawing on the WHO Implementation Guidance (2025), the WHO Policy Brief on PBM (2021), and national policy instruments, the panel identified key barriers, enablers, and strategic priorities for PBM implementation in Portugal. RESULTS: Four strategic domains were prioritised: (1) governance and leadership; (2) education and training across all professional levels; (3) implementation tools and processes, including standardised pathways and goal-directed haemostatic algorithms; and (4) monitoring, audit, and continuous improvement through clinical and economic indicators integrated into dashboards. These recommendations, collectively termed the Valadares Initiative, promote universal PBM adoption, systematic benchmarking, and alignment with national quality and safety frameworks. CONCLUSION: Portugal has the legislative foundation and clinical expertise to advance PBM. Progress now requires stronger governance, adequate resourcing, and structured education. The Valadares Initiative offers a consensus-based roadmap to accelerate PBM implementation and provides transferable insights for other health systems.