E-resources in Tees, Esk and Wear Valleys NHS Foundation Trust


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Considers e-resources as an innovation in health library services and the local obstacles encountered in implementing them

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  • ‘My leadership journey’ in managing LIS has three key ‘ingredients’:Ideas / tools from organisation development – the library in its environment, the culture of the organisation; stretching things a bit to include attitudes to research and to evidence-based practice, and perceptions of LISDiffusion of innovations theory – Everett Rogers and his successors. Rogers defines an innovation as "an idea, practice, or object that is perceived as new by an individual or other unit of adoption”. Can this contribute to a new strategic framework for the delivery of LIS, particularly in relation to the concept of the ‘change agent’?Can the change agent concept be related to the idea of the Team Knowledge Officer as espoused by Peter Hill?I discuss this later.
    An old favourite of mine: studies of information behaviour – what is known through research of how different groups of health professionals search for information, and the barriers they perceive to information seeking.
  • “OD [is] .. OD as an ongoing, thoughtfully
    planned effort by all members of an organization to improve how
    that organization operates, serves its stakeholders, fulfils its mission, and
    approaches its vision.” (Stephens and Russell 2004).
    The following paragraph really leapt out at me when I read this article:
    “Leaders and others in libraries who represent the organization within
    the institution encounter various situations indicating a disconnect between
    the library’s organizational self-understanding and the institution’s understanding
    about the library. The disconnect appears in various settings and
    circumstances, usually based on one (or more) of many possible uncertainties.
    What is the role of the library within institutions (academic and governmental)?
    What is the library’s alignment with institutional goals, expectations, culture, and
    priorities? What are the institutional culture and perceptions of the library’s credibility,
    autonomy, effectiveness, influence, and traditional relationships? How does
    the library stand in the competition for resources?”
  • The National electronic Library for Health (as it was then called) was set up initially in 1999 by Muir Gray. Setting up such a resource was a recommendation of the NHS IT review Information for Health.
    The National Library for Health (NLH) was tasked to deliver a modern, hybrid, networked library service that linked users to digital and physical library service points. Its activities focused on providing organisations with immediate access to the best current knowledge for incorporation into clinical decision tools and the workflow of the NHS. The NLH harnessed three components:
    Librarians employed by health libraries in higher education, third sector and the NHS, who possess the skills for document and knowledge management
    Communities of practice, linking knowledge to the needs of users
    Digital resources and delivery mechanisms to enhance services and new service opportunities
    To manage these components and put them to work, the NLH had an extensive programme of projects and service activity.The National Service Framework aimed to be a quality framework for the delivery of NHS library services, similar in form to the clinical NSFs. It emphasised institutional ownership of LIS. Unfortunately it proved very unwieldy when piloted, and has been radically pruned and amended to form the Library Quality Assurance Framework (LQAF), which was finalised in May 2010.Professor Peter Hill’s review of NHS library services in England was published in March 2008. It was notable for stating four core purposes of NHS libraries: the support of clinical and management decision making, professional development, and research. It greatly emphasised the importance of information literacy training as part of library services. It also proposed that every trust should have a Chief Knowledge Officer, and that each clinical team should have a Team Knowledge Officer. Unfortunately Hill’s proposals were never formally accepted by the Department of Health. ‘Hill’ was in the event overtaken to a considerable extent by ‘Darzi’, which recommended the establishment of a single information portal for the NHS, and led to the merger of the National Library of Health with NICE to form NHS Evidence.
    For the old NLH, librarians were the primary constituency where e-resources were concerned. For NICE, however, libraries/librarians are only one among a range of stakeholders – it prefers to deal directly with clinicians – anecdotal evidence and a recent statement by Gillian Leng suggests that staff of NICE/NHS Evidence do not see a valid role for local NHS librarians in their scheme of things. The national hybrid library strategy, which integrated e-resources with the physical collections and services of local NHS libraries, has been entirely lost.I find myself wondering: has NICE, in aiming to build a single web portal for health information, espoused a ‘build it and they will come’ fantasy? It is noticeable that, other than submitting tendentious articles to professional publications, it undertakes relatively little marketing. It is good that NICE is seeking to engage directly with clinicians, but seemingly it has little understanding or appreciation of the key role that librarians have in information literacy training and in the management and promotion of e-resources.
  • The local picture, I have to say, is one of considerable disadvantage in NHS library terms:
    Historic (early 1980s) MADEL funding allocations led to very poor staffing levels in this area – these sites lost out as they were too far away from Newcastle University Medical School; also money went to the acute trusts.
    In comparison with some other regions (particularly NW) the North East has very little in the way of central support for LIS; the Library and Knowledge Services Manager’s role in and influence in respect of quality and performance management of LIS is very limited – he is also responsible for e-learning – he has recently also had responsibility for JIF and WDIF given him – his role is largely limited to funding purchases of e-content and supporting library management systems. WPH library was scheduled for closure, but was offered space at CLH.RPH library is housed (inadequately) in a small office space downstairs by reception. CLH library shares very cramped premises at present in the Corner House, and has no designated space within the new build at CLH. The Corner House itself is scheduled for demolition. LR library is very attractive, but is already running out of space for current journals, and has its office and journal store situated in the old porters’ lodge some way away across the site.A great deal of library content has been created on inTouch, with links to resources, but hits to the pages are at a relatively low level, suggesting that many people are unaware of its existence; it is too deeply buried in the structure (under Services | Corporate | Library) and there is no ‘quick link’ on the home page. Also there is no library content on the trust web site. The new web portal at http://www.netvibes.com/tewv-lis should improve the library’s electronic presence to some extent, however; its launch has been greeted enthusiastically.
  • By ‘networked information’ or ‘e-resources’ we understand the following: bibliographic databases (e.g. PsycINFO, CINAHL, Medline) delivered via the web; point of care resources delivered via the web; the full text of professional journals and books available in electronic formats. It is a cluster of innovations, which itself depends upon other innovations: the web itself, networked PCs, the Adobe Portable Document Format, etc.The ready availability of information via the web has negatively affected attitudes to libraries, which are perceived to have a much diminished role within a widening information marketplace; people have less and less acquaintance with them.
    For some years the CIBER research unit at UCL has been investigating information seeking behaviour via deep log analysis of web sites, and has concluded that, for all groups studied:Information skills have not improved with widening access to technology
     Little time is spent evaluating content for relevance, accuracy or authority
     Searching is simple – often one-word terms or full phrases
     Young people in particular lack a mental map of libraries, resources and (possibly) the informational structure of subject disciplines(Rowlands 2009)
    Rosamund Bertulis, outreach information manager at the Royal College of Nursing, conducted in 2007 a review of the literature on nurses’ information seeking and found that:“ … perceived lack of time is the main barrier to evidence-based practice for nurses. A lack of information technology skills and access affects nurses' use of research evidence. Nurses tend to base the selection of information sources on convenience and accessibility rather than quality. They also tend to rely on colleagues as information sources and prefer to refer to them than to printed or computerised sources.”Google was preferred over library and professional databases.
    An American writer, Slawson (2005), referring to earlier research on clinician information seeking, states that:
    ‘The more common method of information management has been called “satisficing,” whereby busy clinicians will be satisfied with the information they have at hand, sacrificing quality for convenience. For example, internal medicine residents pursued only 30% of their questions during a typical office session and only pursued 70% when specifically given time during their office hours to answer the questions they developed. Instead of striving to find the most rigorous evidence, most fulltime clinicians report they do very little critical appraisal, instead relying on summaries and practice guidelines, regardless of whether these are evidence based, for information’.
    NHS Athens accounts are required to access most e-resources (databases, e-books, e-journals). The library promotes Athens accounts via its market stall at corporate inductions and via network training sessions conducted by the IDEAs team. Take-up of Athens accounts in TEWV is low. As of 14/07/10 there are 1017 Athens accounts in total. Of these, 64 are held by junior doctors (out of a total of ~80) and 233 by allied health professionals, including clinical psychologists. Only 393 nursing staff have one: around 14% only of the total nursing workforce, i.e. including HCAs and associate practitioners. How, one may ask, are the remaining 86% accessing the professional literature?A most telling comment was made to me at one library committee meeting: “You should not be promoting the library service, you should be promoting evidence-based practice.” While there may be complex cultural factors relating to implementation of EBP, I contend that if clinicians are not as a matter of habit accessing and using high-quality information to develop their professional knowledge and to inform patient care, this will eventually have deleterious effects on the quality of services, constituting a significant risk issue for the trust.You will be familiar in outline with the theory of diffusion of innovations. Moore (1991) depicted in the non-adoption of technological innovations a ‘chasm’ between the early adopters and the early majority.It appears in TEWV that use of networked information is being made by ‘innovators’ and ‘early adopters’, with an ‘early majority’ in some areas, leaving the ‘late majority’ and the ‘laggards’ untouched. These staff may face difficulties in accessing physical libraries and lack confidence in the use of IT; owing to staffing constraints and communication issues within the trust, are well beyond the reach of the LIS’s marketing initiatives.I wonder also whether the technology (navigation, authentication systems etc.) are still too confusing, clunky and error-prone to attract ‘late adopters’? (Treloar, 1999). A lot of people report to us the problems they are having in accessing the full text of articles they find.
  • There has been extensive discussion in the professional literature of the effectiveness of different service models: clinical librarians, outreach librarians, and so on. It has been suggested to me that a mobile library would be an effective way of delivering library services in north east Yorkshire, though I know of no other trust that has gone this way!The concept in diffusion of innovations theory of the ‘change agent’ may have something to say to us here, as I mentioned earlier.Greenhalgh et al. (2004), in their literature review of studies of DoI in health care organisations, identify effective change agents as having the following characteristics:they are1) Homophilous with (i.e. are alike in background and perspective to) the potential users of the innovation and have credibility with them 2) Trained and supported to develop strong interpersonal relationships with potential users / to explore and empathise with the user’s perspective3) Encouraged to communicate the user’s needs and perspective to the developers of the innovation4) Able to empower the users to make independent evaluative decisions about the innovation
    Do librarians fulfil these criteria? For most information literacy trainers I would probably say NO to 1) and 4) and YES to 2) and 3)!DoI research suggests that fellow-professionals who are confident users of e-resources (i.e. who are ‘innovators’ or ‘early adopters’) rather than librarians may be the most effective change agents.The Team Knowledge Officer role was envisaged by Hill (2008) as one of “ensuring the input of evidence to enable their team to deliver the best possible patient care”.I give the description in full, as it is little known. “He/she will support the team through:
    • ensuring the dissemination of externally and internally generated evidence, research,
    information, and data
    • facilitating knowledge sharing
    • participating in horizon scanning by anticipating future service needs
    Works in partnership with the Chief Knowledge Officer by informing him/her about the team’s issues in
    managing knowledge.
    Identifies and participates in relevant networks across the health community in order to make
    best use of all available information resources
    Has an enabling role in supporting excellence by improving:
    • awareness of the evidence
    • access to the evidence
    Identifies relevant colleagues for liaison within and outside the organisation in order to ensure
    the best use of knowledge and experience including: education and training, library and
    knowledge services, information departments, and other providers of knowledge.”
  • E-resources in Tees, Esk and Wear Valleys NHS Foundation Trust

    1. 1. E-resources in TEWV: an innovation stalled? Catherine Ebenezer Effective Leadership Monday 19th July 2010
    2. 2. ‘My leadership journey’ Organisation development  the library in its environment  attitudes to evidence-based practice  perceptions of library services Diffusion of innovations (DoI) theory  use / non-use of e-resources by health professionals Information behaviour  health professionals’ information seeking
    3. 3. Institutional context Library leaders … “encounter … a disconnect between the library’s organizational self-understanding and the institution’s understanding about the library”. what is the role of the library? alignment of the library with the culture and priorities of the institution? how is the library perceived? how does the library stand in the competition for resources? (Stephens and Russell 2004)
    4. 4. Recent history … 1998 NeLH founded 2003? The NLH ‘hybrid library’ strategy 2008 ‘National Service Framework’ for NHS LIS 2008 Hill review – core roles of LIS; CKO / TKO roles 2008 Darzi review  NLH merged with NICE → NHS Evidence  service development stream becomes SHALL  national strategy lost  place of NHS libraries and librarians?
    5. 5. Local history …  LIS strategy 2007: ‘the library on your desktop’ – emphasis on electronic delivery of information  Historic MADEL funding allocations → poor library staffing levels – money went to acute trusts  Lack of effective regional co-ordination – LKS manager for NE is (very) part-time  Limited physical presence  EMT mandated closure of WPH April 2010  New builds at RPH and CLH have limited or no provision for LIS; LR is attractive; overall space for stock is insufficient  Limited online presence – but effect of new web portal www.netvibes.com/tewv-lis ?
    6. 6. An uncrossable chasm?  Networked information / the hybrid library = an innovation cluster  Readily assumed that LIS are no longer significant in information provision, and particularly that ‘digital natives’ readily navigate eresources without LIS intermediation (Selwyn 2009, Rowlands 2009)  BUT grasp of search strategies and techniques is often poor – at all staff levels and in all age groups  The ‘satisficing’ phenomenon (Slawson 2005)  Only 1 in 5 staff have NHS Athens accounts – many clinical staff appear to be unaware of e-resources provided by LIS  ‘EBP’ – in theory, but not in practice? Implications for quality?
    7. 7. The library service as a change agency? Characteristics of change agencies / agents  Homophily / credibility  Develop strong relationships  A channel of communication to the developers / vendors  Empowering users How far can LIS staff fulfil this role? In promoting the use of e-resources, do they need to work closely with ‘champions’ within individual clinical services? (Hill’s Team Knowledge Officers?)
    8. 8. Questions? Please email any questions arising from this presentation to: catherine.ebenezer@tewv.nhs.uk - sorry I couldn’t be here today!
    9. 9. References Greenhalgh, T et al. (2004). Diffusion of innovations in service organisations: systematic review and recommendations. Milbank Quarterly 82(4) 581-629 Hill, P (2008). Report of a national review of NHS health library services in England: From knowledge to health in the 21st century. NHS Institute for Innovation and Improvement Holland, M (1997). DoI theories and their relevance to understanding the role of librarians when introducing users to networked information. Electronic Library 15(5) 389-394 Bertulis, R (2008). Barriers to accessing evidence-based information. Nursing Standard 22(36) 35-39
    10. 10. References Rowlands, I (2010). Research behaviour in the new information landscape. Presentation given at UHMLG Spring Forum 2010. Selwyn, N (2009). The digital native – myth and reality. Aslib Proceedings 61(4) 364-379 Slawson, D C and Shaughnessy, A F (2005). Teaching evidencebased medicine: should we be teaching information management instead? Academic Medicine 80(7) 685-689 Stephens, D and Russell, K (2004). Organizational development, leadership, change and the future of libraries. Library Trends 53(1) 238-257
    11. 11. References Treloar, A (1999). Products and processes: how innovation and product life-cycles can help predict the future of the electronic scholarly journal. In: Redefining the Information Chain - New Ways and Voices : Proceedings of an ICCC/IFIP conference held at the University of Karlskrona/Ronneby, Sweden,10-12 May 1999. Younger, P (2010). Internet-based information seeking amongst doctors and nurses: a short review of the literature. Health Information and Libraries Journal 27(1) 2-10