Systematic Review

Title of project: Case Study Systematic Review

Title: NW Clinical Librarian Systematic Review

Lead library: No lead Library. Contributors from Salford University, Edge Hill University/Aintree Hospital, Univ Hospitals of Morecambe Bay NHS Trust, Bury PCT, Christie Hospital, Blackpool Hospital, NICE/Manchester University.

Summary: A systematic review into Clinical Librarianship will be published in HILJ Dec 2010. This is a collaborative project involving 8 Librarians from the North West. The project contributed to the professional body of work relating to Clinical Librarianship by delivering a Systematic review. In addition, the contributors also developed their own skills base and understanding of the processes involved; this learning will be shared through a reflective process model.

Partner organisations: LIHNN; HCLU

Key Audiences: Clinical Librarians; Library Managers

“The story”: The systematic review aimed to assess the most effective methods of evaluating clinical librarian services. The review was undertaken over a 2 year period and the learning achieved by all concerned was immense. In addition to the main aims of completing the project, the review also identified a dominant model of CL in the UK – one which differed to the original US model. Also through reflective processes the team hope to share their learning, to support other librarians in the health sector who wish to undertake this type of research. The processes involved will be outlined and shared at HLG 2010 and ultimately will be provided via a toolkit. All participants unanimously asserted that they would undertake such a venture again, but would be clearer about the time involved – this was perceived as a key barrier. The richness of the learning experience however, made the experience a worthwhile one.

How the initiative or service is delivered: The project will be published in HILJ Dec 2010 and was presented at EBLIP and ICML 2009. It will be presented at HLG in 2010

Customer involvement in this piece of work – or service development? This project did not involve customers as such.but enhanced understanding of the research process – skills which are integral to the post. By learning valuable skills in the systematic review process, this can be translated librarian support and advice for Trust staff undertaking this type of research.

Benefits of this case – activity – service – for the customer: All clinical librarians felt that it developed their skills and improved confidence in this area. This ultimately will enhance the delivery of librarian support for research (particularly systematic reviews). As a direct result of the experience, the CL at UHMBT felt able to cost librarian time for supporting a systematic review within the Trust.

Benefits for the library/libraries: Raises the profile of the library service within the Trust and the fact that CL’s are actively engaged in this type of work means that confidence in CL ability is improved.

Evaluation: None

Feedback: None as yet

Collaborative working: This regional collaboration across the Northwest has created links and allowed shared learning

Funding streams: Funding for the project was obtained from HCLU to cover some conference costs, purchase of Refworks, Ill’s

Lessons learned: TIME!!! Everyone underestimated the amount of work and time that this review would involve. Lessons learned will be documented in the toolkit and shared with others.

Sustainability; next steps? This project will come to an end shortly, but will be presented via 2 posters at HLG (SR findings; Processes and reflection).
There may be some follow up papers relating to the processes and a toolkit will be developed.

Sources of further information? Not available currently

Start date: April 2008

End date: 31.12.2010 (although may be extended if a further research report undertaken

Contact: Tracey Pratchett
Job title: Clinical Librarian
Telephone: (01524) 516224
e-mail: Tracey.pratchett@mbht.nhs.uk

Aligned to:
Local drivers
UHMBT Strategic Direction Document 2003-8 “We are here to provide … A resource for teaching and research and development, generating new knowledge leading to improvements in population health and in health care delivery”
National drivers
Hill review 2008 highlights that health libraries are essential for supporting clinical decision making, commissioning & policy making, life-long learning and research.
Darzi review

Date submitted: 22.6.2010

Orthopaedic Assessment and Treatment Centre

Title of project: Business Case for the Development of an Orthopaedic Assessment and Treatment Centre and its implementation.

Project Team:
Business Case
Directorate Manager of Orthopaedic Services, Directorate Manager of Emergency Services, Associate General Manager Orthopaedics, Knowledge and Library Services Manager, Director of Finance.
Implementation of Business Case
The group of people above plus: orthopaedic consultants, orthopaedics nursing staff, physiotherapists, occupational therapists, radiology department, estates, IT department,

Resources Required: Capital Funding

Timeframe: Three month turnaround for the business plan then 12 months for implementation

“The Story”: The library service was asked to be part of a project to develop an assessment and treatment centre for orthopaedic patients on the Chorley Hospital site. This was in response to a public consultation carried out with the population of Chorley and South Ribble. The Knowledge and Library Services Manager (KLSM) was asked to be part of the project team and to provide information via literature searches to support the business case. The topics included: Independent Treatment Centres, best practice and the clinical pathways on the map of medicine. Once the business case had been approved the KLSM was assigned a coordinating role and produced the weekly checkpoint reports after each meeting and chased actions to ensure they had been completed for the next meeting. In addition to this, the Library Manager was asked to design, co-ordinate and write a report on the findings of 3 patient surveys and 1 survey to find out about staff views on the new service and how the new ways of working had affected them.
The first questionnaire was sent out to patients who were using the existing service to obtain a baseline measurement and discover areas for improvement. The second survey sent out to patients was to provide feedback about the piloting of the new service and if there were things that still needed to be improved. The last patient survey was undertaken three months after the new service had been commissioned. All three surveys were then compared to discover how the old and new services compared and how to see how patient outcomes had improved.
The staff survey was sent out after the pilots to
highlight if there were any further training needs and how they were managing the transition to the new service.
During the business case phase there were two meetings a week to ensure momentum was kept. Once the project had been approved the meetings were weekly. Time to design, send out and report on the surveys was also required.
The expected outcomes were:
The ability to compare the previous delivery of the Orthopaedic Outpatient service with the delivery of the service provided by the ATC
To provide a template that could be used to deliver other patient services using the ATC model
To compile a list of lessons learnt to improve the delivery of the existing Orthopaedic ATC and could then be incorporated into other ATC services as they come online
To collect data from the delivery of the traditional service model, the pilots and the current service to provide a benchmark to measure the effectiveness of the new ATC model.
To provide a one stop shop for patients which would allow all their tests and diagnosis be carried out on one visit.

Alignment to local, regional and national drivers:
Achieved library service objectives by:

  • Participating in the delivery and maintenance of Trust initiatives.
  • Raising the profile of library services to specialised groups.
  • Supporting evidence-based practice in projects.
  • Maintaining and develop internal partnerships with departments.

Worked towards local, regional, national drivers by:

  • This project linked with the Healthier Horizons for the North West agenda by involving front line staff to be at the heart of the decision making process, to improve patient care and access to services.
  • The NHS Plan identified that there was a need for greater choice for patients on how and where they received their treatment. This development was in response to this need.

 

Impact of this project/service for the:
• customer • organisation • library
The objective of collecting the data from the traditional service, the pilots and the new service was to provide benchmarking information to evaluate whether the new ATC service had delivered any improvements and had increased it’s effectiveness with regard to patient care.
Analysis of the data suggests that the new service is delivering a better service than the traditional service in the following areas:

  • Improvement in booking-in at arrival for the appointment.
  • Patients’ perceptions were positive with regard to: the environment, infection control and being treated with dignity and respect.
  • The new facilities have had a very positive reaction from patients

The project resulted in changes to working practices and the development of a new role i.e. the Patient Experience Co ordinator. The new working practices have required existing staff to undertake a training programme to address these needs.
In addition, a new orthopaedic pathway has been developed and implemented for patients.
Involvement in this project has raised the library services profile and has highlighted that librarians have skills that can be used to deliver and enhance trust projects. One noticeable benefit has been that managers are using the library service more to find evidence when implementing new services and the KLSM is being asked to be involved in other Trust wide projects.

Lessons Learned:
Being involved in this project has provided the following benefits:

  • Increased knowledge of how the organisation works and departments interact with each other.
  • Increased knowledge on how staff work in out patient clinics and how this has highlighted the difficulty staff have inaccessing information due to time pressures within clinics.
  • Highlighted to managers that the library service has more to offer than their traditional supporting role for the delivery of educational programmes and have skills that are valuable to the organisation and them.
  • Identified champions who support and recognise the library service’s worth to the organisation.

Issues

  • Being part of this type of project exposes the participant to the frenetic way managers and clinical staff have to work. Deadlines are always short and are expected to be met. Initially, this can be an issue and adjustments need to be made to cope with this way of working.
  • Workload can be an issue, as often you will be expected to deliver your identified deadlines within the project and continue to do your existing role at the same time.

Sustainability / next steps? The project has know been completed. However, the KLSM is still receiving e-mails and telephone calls from new users who have been told to contact the library service with regard to information provision for new service development and redesign.
Literature searches on management topics are now offered and the library’s daily health management newsletter reflects manager’s trust priorities.

Contact details: Mandy Beaumont, Knowledge and Library Services Manager
Mandy.beaumont@lthtr.nhs.uk

Date case study completed: 01.12.10

Journal Streamlining

Title of project: Streamlining of Trust Journal Management

Project Team:

  • Susan Smith – Senior Librarian (project lead)
  • Jill Lucas – Supplies Administration
  • JET Library Steering Committee (advisory)
  • Library staff for day to day tasks.

Resources Required:

  • Ebsco – subscription agent
  • Journal subscriptions
  • Internal mail
  • NHS Link resolver
  • NHS A-Z journals list
  • Catalogue (University of Chester)
  • Departmental contacts

Timeframe: Ongoing – to be initiated Jan 2011

“The Story”: Historically the journal subscriptions for the Trust have been managed by the Supplies Department. As a result online access had never been activated or linked into other electronic resources. There was also evidence of a number of duplicate purchases taken by the Trust.
Errors in postal addressing, has lead to failure in subscription delivery. Over a 3 month period of postal errors, no departments claimed issues not received.
The Library is now working with the Supplies Department to transfer the management of the journals across to the library, to ensure proper access, de-duplication, alignment with national procurement and provision of a journal receipt service.
Departments have been contacted and have granted different levels of library involvement with their subscriptions. All departmental purchases will be received and check-in by the library and forwarded on to the department as required. The library consults with departments and supplies in an advisory capacity at point of renewal. Most departments have opted for the library to manage electronic content and have provided a list of departmental holdings for inclusion on the link resolver with arrangements for staff access to departmental collections.
Departments were fully consulted before implementing the service, all with extremely positive views.
The library will be responsible for the addition of subscriptions to the library catalogue and link resolver. It addition will activate any online access.
Initially it will take 3 hours of time at start of the year to add to current systems and will add 10 mins per week to the current journal check-in procedure.

Alignment to local, regional and national drivers: The library aims to streamline the journal subscription process, maximise the usage of resource and improve visibility. Through departmental discussion it aims to prevent duplication and rationalise resources as a way of saving money.
QUIPP
Darzi report
NHS White paper

Impact of this project/service for the:
• customer • organisation • library
The project will be evaluated by review meetings with the supply department and a follow up survey of the departments to ensure they are happy with the service.
There has already been the cancellation of 7 journals as a result of duplication.
There has already been an increase in the use of NHS Athens accounts as a result of discussions.
New links with departments have been created with view to other joint projects and promotion of library services.

Lessons Learned: Uptake has been better than expected with only two departments not allowing staff access to the journal, but one will supply to library after departmental circulation.

Sustainability / next steps? More will be know after the project takes effect and has been fully evaluated.

Contact details: Susan Smith – susan.smith@chester.ac.uk

Date case study completed: 08/09/10

Drugs: The Evidence

Title of project: Drugs: the evidence

Project Team: A plus other members of the library service team

Resources Required: Brass neck to gain access to sponsored medical meetings
Ability to carry out, understand and summarise the results of a brief literature search
Ability to publicise the results of the search via intranet and/or email

Timeframe: 2010-

“The Story”: Dissatisfaction with the facility for pharmaceutical company staff sponsoring Trust medical meetings to hand out publicity materials which may not present the whole evidence about the efficacy of the products they are promoting. Library staff now infiltrate these meetings, and seize examples of the publicity materials. Advertised products are then subjected to a literature search, with a concentration on high-quality, up-to-date evidence. This results in a short summary of the findings which is posted on the Intranet. Selections of these summaries are emailed out to Trust physicians and local GPs at regular intervals inviting feedback.
Searches and summaries take no more than half an hour. The idea of the service is to encourage doctors to challenge the “evidence” presented by the drugs companies, rather than to present the “last word” on the topic.

Alignment to local, regional and national drivers: Hill Report emphasis on working outside the library comfort zone e.g. in clinical areas
Annual statistical return demand to report on search emanating from non-library areas
LQAF

Impact of this project/service for the:
• customer • organisation • library
Feedback includes:
1 Tongue in cheek comments about library staff endearing themselves to drugs reps
2 Email from doctor claiming that he had evidence that drug P was less cost-effective than the evidence I had cited suggested. I emailed him the Health Technology assessment which had reached the conclusion I quoted from and have not heard from him since.
3 Query from GP Lead prescriber at local PCT about why so many patients appear to be started on medication X by Pennine Acute doctors when the evidence appears to suggest that X is no more effective than a cheaper alternative. Passed this on to Drugs Information Pharmacist (who was happy to deal with the question) as this is obviously beyond the remit of a non-clinician

Lessons Learned: Take care to cover your back by ensuring that you quote directly from evidence (usually abstracts) so as not to give the impression that a librarian is interpreting evidence and advising on clinical decisions.
I’ve ignored this advice twice, in order to demonstrate how drugs companies misled doctors by citing relative risk rather than absolute risk but ensured that what I wrote was factual rather than interpretive.
More difficult to enthuse staff on other sites with the idea of sneaking unobtrusively into medical meeting to filch leaflets than I had originally expected. I suspect that there’s still a feeling that entry into these meetings (even during the pre-meeting lunch) is rather more difficult than entering a Masonic lodge.

Sustainability / next steps? Interest in the project appears to be growing. I’ve only just started to circulate summaries to the GPs and suspect that this may create more interest with this group than I had originally anticipated, as prescribing decisions taken by hospital doctors may have considerable long-term implications once a patient’s care returns to his GP.

Contact details: John Addison. Pennine Acute Hospitals NHS Trust. john.addison@pat.nhs.uk

Date case study completed: 8 September 2010

Statistics Mentoring Clinics pilot

Title of project: Statistical Mentoring Clinics pilot

Lead library:

Summary:A series of 8 Statistical Mentoring Clinics were offered to WUTH staff between January and July 2009, facilitated in partnership between Wirral University Teaching Hospital (WUTH) Integrated Library Service (ILS) / Research and Development (R&D), and Upton Hall School as part of a community engagement arrangement.

Partner organisations:

The project team consisted of representatives from the WUTH Integrated Library Service, the WUTH Research and Development department, and Upton Hall School:

  • Eileen Hume, Head of Trust Integrated Library Service, WUTH
  • Lisa Anderson, Business Intelligence Service Project Manager, WUTH
  • Victoria Kirk, Clinical Librarian, WUTH
  • Professor Rod Owen, R&D Manager, WUTH
  • Ben Cribb, Director of Specialisms (Technology and Communications), Upton Hall School
  • Nigel Gorman, Head of Mathematics, Upton Hall School

Key audience: WUTH staff who would benefit from extra support when faced with using statistics in practice and / or research.

“The story”: For some time the ILS had been approached by library users asking for support in statistics and SPSS training, required by WUTH health professionals in order to support their research work. WUTH no longer had access to the expertise of a statistician within the Trust.
Following an initial meeting involving the project team (as above), a series of 8 Statistical Mentoring Clinics were held at the McArdle Library, Education Centre, Arrowe Park Hospital, with the aim of providing a statistical mentoring clinic for WUTH staff who would benefit from extra support when faced with using statistics in practice and / or research.
Dates and times of the clinics were agreed in advance and then advertised via the ILS training programme and blog. Participants were asked to book their place via the ILS web pages and were able to book time slots of 30 minutes during this specified period.
Those attending the clinic came prepared with a statistical problem or scenario. Where it was not possible to solve statistics problems directly within the clinic, an action plan was drawn up jointly between the facilitator and the attendee to establish a direction of travel towards a solution.
The statistical resources and programs that were supported included Microsoft Excel and SPSS (Statistical Package for the Social Sciences).

How the initiative or service is delivered: Clinics were delivered on a one-to-one basis due to software licensing arrangements.
Clinics were held within the IT Training Room within the McArdle Library in the Education Centre at Arrowe Park Hospital, which provided access to 6 PCs.
ILS staff presence was necessary to provide access to the Training Room and offer refreshments to visitors.
Clinics were arranged to run between 4.00pm and 6.00pm to cover the ‘twilight’ period between staff shifts, in order to encourage a greater number of participants.

Benefits of this service for the customer: WUTH staff involved in research activities were able to access support and expertise for statistical queries.

Benefits for the library: The ILS was able to expand its portfolio of services and offer a specialised service to researchers within the organisation.

Evaluation: In total, four participants attended the advertised clinics. All participants requested two time slots, in order to spend an hour at the clinic.
Each participant was asked to complete an online evaluation questionnaire following their attendance at the clinic. 2 evaluation questionnaires were received.

Feedback: Please see below the evaluation questionnaire results:
Please tick whether you disagree or agree with the following statements:
I will use this resources / material again 100 % of respondents agree
The session was delivered at the right level of complexity 100 % of respondents agree
The visual aids and handouts were useful 50 % of respondents agree, 50 % of respondents neither agree nor disagree
The trainer has good knowledge of the subject 100 % of respondents agree
How would you rate the following aspects of the training accommodation? From 1 to 5 (1=poor, 5=excellent)
Seating  comfort                                      4                                   5
Noise level                                               5                                   5
Lighting                                                    4                                   5
Temperature                                            4                                   5
Cleanliness of room                                 5                                  5
Breaks (if applicable)                               4                                  5
e.g. time allocated, facilities available

Further comments
“Very calm and comfortable learning environment. Felt most welcome by all members of staff.”
Which aspects of the session did you find the most useful?
“Ability to take own statistical problem along to work through with tutor.”
“To be able to discuss the statistical problems on a personal basis. Various problems were explained to me that I would not have been able to understand for example by reading a book. I was most grateful for this.”
Was there anything you expected to learn in this session and didn’t?
“I learnt more than I expected.”
What will you be able to do tomorrow that you couldn’t do before today’s session?
“I have a better understanding of why the tests are performed and what outcome(s) are desirable from a significance perspective.”
“I would feel more confident to interpret data, and attempt to analyse it rather than feeling completely intimidated by it all.”
Would you recommend this session to a colleague?
100% of respondents said yes
Overall how would you score this session out of 10
(0 = Poor, 10 = Excellent)
Average score 9 out of 10
Please summarise your overall impression of the training session in one sentence:
“Very approachable tutor. Hands-on approach to solving problems.”
“The statistics clinic is an excellent resource that will support and encourage clinical staff to carry out and develop their own research skills.”
Further comments
“The statistics clinic should be widely advertised throughout the hospital, so more staff can benefit from it.”

Marketing: A ‘soft’ marketing approach was taken since this was a pilot project. The clinics were advertised via the ILS training programme and blog. The clinics were also publicised via word of mouth to health professionals known to the ILS and the R&D team as being interested in statistical support. This approach targeted the right audience but did not attract large numbers; there were some advertised clinics which had no participants in attendance.

Collaborative working: The project involved collaboration between the ILS team, the R&D team and the Upton Hall staff. An initial meeting was held to scope the project; following that, communication was mainly by e-mail. The success of this collaboration relied on regular contact by e-mail to confirm dates, participants and statistical scenarios prior to sessions.
The different working patterns of the staff involved had to be taken into account; Upton Hall staff were only available to deliver sessions during school term time and during twilight hours, usually 4pm – 6pm.

Funding streams: The SPSS licence was funded by the WUTH R&D department.

Lessons learned: The feedback indicates that the content and method of delivery of the sessions was a success; wider publicity within the organisation would enable more WUTH staff to benefit from these sessions.
The clinics were offered as 30 minute time slots, but all participants requested an hour at the clinic, suggesting that longer time slots are preferable. Any future clinics could offer an hour-long time slot as the minimum.

Sustainability: The pilot project consisted of 8 sessions over a 7 month period; further discussion may be needed to examine whether this level of commitment is sustainable for the staff involved.
Sustainability of the clinics would also depend on increasing the numbers of health professionals in attendance; this would require a wider marketing strategy. The possibility of offering the clinics to other organisations within the wider Wirral Local Health Community (Clatterbridge Centre for Oncology, NHS Wirral) might also be considered.

Sources of further information?

Start date: 1st January 2009

End date: 31st July 2009

Contact:

  • Lisa Anderson, Business Intelligence Project Manager, Landerson@nhs.net
  • Victoria Kirk, Clinical Librarian, Victoria.kirk@nhs.net

Telephone: 0151 604 7223

Date submitted: 9th November 2009

Develop and populate a library wiki

Title of project: Develop and Populate a Library Wiki

Project Team: The project was commissioned by the following 9 NHS Trust Library Services: Wrightington, Wigan, Leigh NHS Trust ; Salford PCT; Ashton, Wigan, Leigh PCT; Bolton PCT; Oldham and Tameside & Glossop PCTs; Bolton, Salford & Trafford Mental Health Trust; Royal Bolton Hospital NHS Trust Bury PCT Manchester PCT
The chosen Project suppliers were Christies managed by Steve Glover. Steve contracted – in other expertise from elsewhere in the region.
Local involvement , all members of the library team were involved in discussions around content and customisation
Diane Geldard Library Manager was a member of the PEAR project board
Julie Wickham Assistant Librarian developed content. reviewed and revised content from the library intranet pages for transference to the wiki
Ruth Massey , Laura Drummond Library Assistants customised the individual pages, added content from the intranet site and new content

Resources Required: The project was funded by the North West Health Care Libraries Unit (HCLU) after a joint bid from the libraries involved Wrightington, Wigan, Leigh NHS Trust was the lead bidder and the funding was available for a 12 month period only.
Using a local supplier (Christies) money was saved and 18 months of development and support were able to be negotiated with the funding available
Time was required to attend Project board meetings these involved reports on progress, demonstrations and some training
Information and updates were also conveyed by email and PEAR wiki
Locally members of the project suppliers came on several site visits to benchmark, provide training and discuss local development areas, this involved both library manager and assistant librarians time
Once the structure of the wiki was set a lot of staff time was needed to customise the wiki i.e. colour, look etc
Populating the pages was time consuming as was the transfer of documents from our intranet to wiki. However once this was all done keeping it up to date and revising is quite quick.
Initial requirements were access to Internet Explorer 6 but have needed upgrading to Explorer 7 as PB works where the wiki is hosted
no longer supports E6

Timeframe: Initial setting up phase 2007-2009
Local customisation phase 2009- 2010
Revision and development of new content ongoing

“The Story”: The development of a library wiki was undertaken as part of the PEAR project (Project for Electronic Awareness and Resources)
The Project was established to provide aid to a number of smaller Greater Manchester NHS Libraries which were unable to employ an Electronic Services Librarian. As part of this project one of our particular requirements was for a library wiki to be developed for use by staff in NHS Oldham and NHS Tameside & Glossop as many of our users are remote from the main library and unable to access either organisations intranet where the library information pages were and we were unable to get library information on either organisations internet pages
As part of PEAR project the main structure of the site was developed by the suppliers expert team they then delivered to us the bones of the wiki leaving the library team to populated the pages and change the design to suit us locally
Initially library/manager assistant librarian identified content for the wiki pages the library assistants then populated the wiki customising the design , adding local links , keeping the site up to date
All our Intranet pages have now been replace by the wiki
Minimum amount of time is now taken to update the site on a regular basis
The wiki can be viewed at http://otgpear.pbworks.com

Alignment to local, regional and national drivers:
Local: Library Accreditation Report 2008 Recommendations
Increase access to remote users
Access to help 24/7
Encourage use of evidence based resources
Embrace new technologies
CPD opportunities t for library team
Regional: HCLU Strategy
Modernising NHS Library/information services
Creating effective partnerships
National :
Darzi: Easy access for NHS staff to evidence based information
Hill: Support research and lifelong learning providing access 24/7 from any location
Support research and lifelong learning providing access 24/7 from any location

Impact of this project/service for the:
• customer • organisation • library
No longer reliant on 2 different organisations web editors to update library intranet pages.
Editorial freedom for library team
Easier and quicker to revise and update information
Enhanced skills of library team
Intranet pages were very difficult to locate
Accessible 24/7 from any PC with internet access
staff working in the community based in non NHS buildings could not access the trusts intranet pages but can access wiki
Library Help sheets, Research pack information etc available from wiki which has reduced the amount of printed material which is sent out to users
Short easily located wiki address
Information on the wiki is more up to date
Links to wide range of evidence based sites
Collaborative working partnership and joint bid with other health libraries attracted outside regional funding for the project from HCLU

Lessons Learned: As a small library team with no e -librarian we would not have been able to progress with setting up this ourselves due to lack of expertise time and funding. The collaborative nature of the project worked very well with plenty of opportunities to contribute to the project from start to finish and to be able to tailor deliverables to our own library needs. Much was down to the tight brief that was developed at the start of
the project.
It was very helpful to have site visits from members of the supplier team during the course of the project who were always very supportive
and to have a manual to remind us how to do
editing etc. We are still able to contact a member of the supplier team if we have any problems
Once we had the structure of the wiki developed we still found as a small team that time and lack of confidence with regard to editing was our main problem and we underestimated the amount of time taken to customise the site. There is a need to allocate protected time/staffing to populate wiki. A library team member who has quick keyboard skills is a real bonus
On reflection it would have been useful to have undertaken a user survey before we launched to gauge what our customers would have liked to see on the site, then a quick survey shortly after launch to see if users had been looking at the site and what were their initial thoughts.
We need to do a survey 6- 12 months
after launch to evaluate usefulness, ask for ideas get an idea of usage figures

Sustainability / next steps? We will continue to update the wiki on a regular basis and assess new ideas for information to be added.
We will aim to carry out a User survey via survey monkey on usage and possible areas for development. Ideally our library assistant would regularly update the site and add content but funding has been withdrawn for our Library Assistant Post
Further work, development and collaborative opportunities this year (2011/12) will be dependent of the future direction of our Library Service as it becomes part of Stockport FT

Contact details: dgeldard@nhs.net

Date case study completed: 27/05/11

Knowledge @lerts for NHS Central Lancashire

Title of project: Knowledge @lerts for Central Lancashire PCT [CLPCT]

Project Team: Sarah Ramsbottom [SR] (PCT Liaison Librarian); Jeanine Fielding (Operational Library Manager),
Library & Information Service, Lancashire Teaching Hospitals NHS Foundation Trust.

Resources Required: No additional costs. Librarian’s time & skills: search skills; wordprocessing; emailing. Technology: computer based programmes, eg. Wordperfect, Outlook email.

Timeframe: August 2010 – March 2011

“The Story”: As part of the delivery of services to CLPCT it was decided to develop a series of highly specific Knowledge @lerts targeted at various groups within CLPCT, eg. School nurses, podiatrists, dentists. This decision was reached after analysing responses to the “Central Lancashire PCT Library Information Needs Survey”, (September 2008), but actual action had to wait until the appointment of an additional assistant librarian, part of whose role was to act as the PCT liaison librarian.
The @lerts were designed to deliver subject specific information (eg. new books in the library, new guidance issued, recent articles) in an attractive, easily read format, direct to PCT staff via email.
SR was to provide the @lerts on a quarterly basis to different target groups within the PCT. Names of staff within the groups were identified via a variety of means, eg. Outlook Address Book; PCT lead contacts providing names of others within their department.
It was envisaged the initial template set up and composition of the first edition in each subject area would occupy around 80 hours work. Thereafter, each quarter, approximately 20 hours was to be spent developing each succeeding series of issues.

Alignment to local, regional and national drivers:
Library service objectives:
1. Expand range of value added services offered to PCT staff
2. Increase use of LTH Library Service by PCT staff
(Both of these are part of the PCT clause contained within the Library Objectives section of the Library Business Plan.)

Impact of this project/service for the:
Project aims were:
For PCT Staff: Provide CLPCT provider staff with work specific information they might not have otherwise known about, eg. alert them to new NICE guidance covering their area.
For PCT: Better informed staff delivering the right intervention at the right time to the local population.
For LTH Library: Encourage use of the Library by PCT employees, helping to
demonstrate the value of the Library service (and therefore the cost benefit of the contract) to PCT management.
Evaluation to demonstrate impact: The PCT Knowledge @lert service only commenced in August 2010, (to date only 4 issues in each subject area have been distributed) and it was planned to undertake an evaluation at the 12 month mark.
Nb. This evaluation will not go ahead, as with the gradual dissolution of the PCT, the contract for delivery of library services has not been renewed.
Although formal evaluation will not take place, there has been substantial informal feedback and observation to show that the @lerts have been appreciated by PCT staff.
A condensed and relevant information source was highly valued by those staff receiving the @lerts. This was evidenced by:
~ the large range of (unsolicited) positive feedback obtained from staff receiving the @lerts, for example:
“The awareness bulletin you have done for the OTs is fantastic”
“Please would you send me the physiotherapy quarterly bulletin to my home address as I work on a bank contract and don’t want to miss any!”
“Please please keep sending it, that’s great. May have a few more to add to your list, can I forward email to other colleagues? ”
What a great bulletin! I’d like to keep receiving them please! As a fairly new member of staff you’ve just answered about 5 of my questions at once, I’ve signed up for my Athens password as well!”
~ the number of PCT staff sent an @lert, who then registered to use the Library Service
“Thanks very much it’s a huge help – what is the procedure for borrowing the two books from the library?”
~ the number of follow ups from PCT staff resulting from items mentioned in the @lerts (for book loans, article copies, more information about guidance etc.,)
“Thank you so much for the articles (from Practice Nurse Bulletin – issue 2). They are really useful for me as I am undertaking the Nurse Prescribing course at present”
“Thanks for the bulletin it’s very helpful. Please could you e-mail me the following articles” (4 articles were then requested). Also could you do a literature search for me if possible on the Cognitive Orientation to Occupational Performance (or CO-OP) approach.”
~ the number of PCT staff who were not on the original lists to receive the @lerts, but who asked to be placed on the email groups, after having read an @lert forwarded to them by a colleague.
“Hi Sarah, please could I receive this quarterly bulletin. Thanks.”

Lessons Learned: SR did not require any training to produce the @lerts, as she used her existing skills to do the database and internet searching, word processing, and emailing.
The most difficult aspect of the service was trying to identify possible PCT staff within each target group via the Outlook email system.
Uptake of the @lerts was greater than anticipated. Those on the initial email list forwarded copies to colleagues and as a result we received requests from many PCT staff to be added to the distribution lists. We also had requests to produce @lerts in other subject areas, which was done.

Sustainability / next steps? The most disappointing aspect is that due to the recent re-organisation of NHS services, the LTH Library Service will no longer be serving CLPCT provider staff. This means the service will cease as of 31st March 2011 and provider staff within the PCT will no longer receive the Knowledge @lerts.

Contact details: Jeanine Fielding

Date case study completed: 27th May 2011

Nursing Supplies Group

Title of project: Nursing Supplies Group

Project Team: The group will co-opt new members as required:
Head of Procurement and Supplies, (Project lead); Productive Ward lead/Senior Nurse; Clinical Librarian (Tracey Pratchett); Nurse Practitioner; Accountant; Infection Prevention Matron; Lead Nurse – Productive Ward; Clinical Skills Lead; Midwife; Ward Manager; Practice Educator Paediatrics; Occupational Health representative;
Critical care representative

Resources Required: Library resources: Clinical Librarian time (meeting attendance 4 hours per month, literature searching and synthesis approx 7.5 hours per month) Supplies account for document supply.
Intranet: Supplies Group rep will manage the Intranet content.
Cutepdf (free license)

Time frame: Oct 2009 – April 2012 (Project and Clinical Librarian involvement will continue after April 2012)

“The Story”: The University Hospitals of Morecambe Bay NHS Trust is committed to providing high quality research based care within the resources available. The purpose of the Trust Supplies Group is to consider the research around the clinical efficacy and safety of clinical items available for use and make recommendations based on clinical and cost effectiveness. The Trust Supplies Group meets once per month and the Clinical Librarian attends all meetings.
In October 2009 the Clinical Librarian was invited to attend the Trust Supplies Group to deliver literature searches to support decision making around procurement. The savings target to be delivered by the group by April 2011 was £100,000. It was agreed at the first meeting that the Clinical Librarian would carry out searches for those items where a procurement decision would have some impact on clinical practice. Early in the process it became apparent that the group needed more than the delivery of a standard list of results and subsequently, evidence was synthesised into a standard 2 page format which would underpin recommendations made by the group when necessary (some procurement decisions are a straightforward swap and no evidence base needed). Once recommendations are agreed and the change to procurement practice made, the summary is posted onto the Supplies Group Intranet pages.

Alignment to local, regional and national drivers: The procurement of consumables by NHS acute and Foundation trusts (Feb 2011) National Audit Office “NHS hospitals often pay more than they need to when buying basic supplies, the National Audit Office has reported. A combination of inadequate information and fragmented purchasing means that NHS hospitals’ procurement of consumables is poor value for money.”
University Hospitals of Morecambe Bay NHS Foundation Trust Strategic Objective No 5 Business Plan 2011-2012:
“Give our patients value for money and provide sustained long term financial viability”

Impact of this project/service for the:
• customer • organisation • library
In 2010-11 the Nursing Supplies Group saved £100,000 and in 2011-2012 savings of just under £250,000 on procurement across the Trust.
A representative from the Supplies Group contributed to the interview element a current NW evaluation of Clinical Librarian services so it will be interesting to find out more about the perceived impact of the Clinical Librarian impact on the group and its decision making practices. The interviews were conducted by a Clinical Librarian from outside the Trust, to avoid bias.
The Library has made links with a number of Trust staff and have achieved greater understanding of the issues relating to procurement and clinical practice.
Winner of the Sally Hernando Award 2012.

Lessons Learned: Not every product change requires a detailed literature search, searches are only required when a product change may result in a change in clinical practice.
Excellent opportunity for library staff to collaborate with cross bay teams and have greater impact on evidence based procurement decision making.
Ongoing Clinical Librarian contribution is valued by other members of the Supplies Group.

Sustainability /next steps? The Clinical Librarian continues to be embedded in the Nursing Supplies Group for the foreseeable future and the work has been integrated into day to day workload.
However, the role of the group and the Clinical librarian’s role within that group may change as procurement practices become standardised across the Trust and different issues/approaches arise.

Contact details: Tracey Pratchett Clinical Librarian; University Hospitals of Morecambe Bay NHS Foundation Trust
(01524) 516224
Tracey.pratchett@mbht.nhs.uk

Date case study completed: 28th February 2012

The power of information

Title of driver: The power of information: putting all of us in control of the health and care information we need

Source: Department of Health

Link to main document

Publication format: PDF

Date of publication: May 2012

Summary of driver: It is a 10-year framework, rather than a detailed strategy for delivery.  The strategy document states that it ‘focuses on information in its broadest sense, including the support people need to navigate and understand the information available’ (2012: 5). The rationale given for this is to ensure that information is available in ways that reduce health inequalities, rather than being increased as a result of the ‘digital by default’ approach in the broader strategy (2012: 15).

Key features of driver:

Changes to national information delivery: NHS Choices and NHS Direct will be replaced with ‘a new, single website “portal”
provided by the Government from 2013.

Support and information: The strategy makes several references to ‘support’. These references can be used to
promote information services.

Health literacy: The strategy supports the development of health literacy (2012: 54). It suggests that health trainers may play a role in supporting health literacy, although this is also a role on which health information services and health libraries can lead.

Information skills: The strategy indicates that health and social care professionals are key ‘information givers’ and that they need to have relevant skills to offer information (2012: 67).

Service integration implications: There is an explicit expectation that patients’ NHS Number will be used as a means
to identify individuals and to integrate their experience of care.

Primary audience: All NHS Trusts.

Impact on library policy/practice: Despite the statement that the strategy concerns ‘information in its broadest sense’, the main focus of the strategy is on data and the role that data can play in supporting high-quality integrated services.  The strategy does not discuss libraries or information services, but it emphasises the importance of support, information skills and health literacy, which provide potential opportunities for library and information service providers. The only explicit reference to information services is that ‘the NHS Commissioning Board will wish to consider publishing commissioning guidance on support, information and advocacy services’ (2012: 66); such guidance could be valuable for ensuring the future of public-facing services.

Case studies / Local service profile examples mapping to this driver: None as of 21.8.12

Date last updated: 20.9.12

Due for review: 21.8.13

Group member responsible: Not yet identified

Department of Health Information Strategy

Title of driver: An information revolution: consultation on proposals

Source: Department of Health

Link to main document

Publication format: Consultation (closes 14th Jan 2011)

Date of publication: October 2010

Summary of driver: A consultative information strategy for NHS England which examines the information needed for patients the public; for professionals, for improved outcomes and for autonomy, accountability and democratic legitimacy. Responses to consultation required by 14 January 2011.

Primary audience: All NHS organisations in England

Impact on library policy/practice: Key references are beloiw. Important that all library services contribute to their Trust’s response to the Consultation. Take particular note of chapter 4 on the information needs of professionals.

SECRETARY OF STATES INTRODUCTION:
High quality health and care services depend on good information. The right person having the right information at the right time can make all the difference to the experience of a patient, service user or carer. Good information also enables care professionals to make the process of care safer and more efficient. Information is a health and care service in its own right: it must be freely available to all who need it.
Good information is also the basis for genuine shared decision-making: ‘no decision about me, without me’. We all know the difference between being informed by a service and being left in the dark, and we all know which we prefer. We also all know the experience of receiving volumes of inconsistent or poorly organised information, which can confuse as much as inform.
Information needs to be accessible to all, relevant and well-structured. At present, many people who use our health and care services do not get the information they need and are entitled to expect as part of the care process. Also, we sometimes fail to meet the information needs of our clinicians and care professionals. There are, however, a number of health and care services today where patients, service users and carers are being well-informed and supported to make decisions effectively – we want to build on these successes and on the good practice that already exists.
We need an information revolution to ensure that what is currently seen as good practice becomes the norm. We must not lose sight of the primary purpose of information in the health and care system: to ensure that every patient and service user receives high quality care. ”

“KNOWLEDGE” mentioned in the following sections:

supports clinicians and other care professionals to give the highest quality care, compare their performance with others, identify gaps in provision and develop their knowledge;

supports researchers to advance medical and scientific knowledge
p12

The outer circle (above) shows how data from the patient or service user’s care record, leads to high quality information that gives people real knowledge and choice. The inner circle shows how giving patients or service users control of the data held within their record benefits them, as well as those providing their care. This is discussed in more detail in chapter two.
p13

researchers (confidentially or in anonymous form), to play a part in building up the knowledge that leads to better health outcomes for themselves and for others in society.
p18

The care of the future will, increasingly, be structured around a conversation between the patient or service user and the professional, either through face-to-face contact or remotely, such as through the care record. This will be a genuine dialogue in which each brings an important perspective to bear: the care professional brings knowledge about conditions and treatment options; the patient or service user brings individual needs, protected rights, values, preferences and personal circumstances. The principles, values and rights that underpin this approach are set out in the NHS Constitution
p22

People are more likely to engage appropriately with care professionals and receive the care they want and need. Good support, training and education – backed by relevant, accessible information and support – are the basis for improvements of this kind. The QIPP22 long-term conditions programme is already working with local health communities to ensure patients have access to information and knowledge to help them manage their conditions and avoid inappropriate hospital admissions
p26

Research is vital in providing the new knowledge needed to improve health and care outcomes and reduce inequalities. When resources are under pressure, research can identify new ways of preventing, diagnosing, treating and managing disease. Research is essential to increasing quality and productivity of the NHS and social care services and supports growth in the economy. Outcomes will improve most rapidly when clinicians and care professionals are engaged so that creativity, research participation and professionalism are allowed to flourish
p34

Electronic care records and the wealth of structured data within them are potentially rich resources for applied research – for example, by making aggregated, anonymised data available to universities and other authorised researchers. There is also great potential to build new knowledge that will improve health outcomes and to identify new areas for research. The Government is considering how to provide a high quality research data service that will harness this potential.
p38

“EVIDENCE” mentioned in the following sections:

the need for high quality evidence – from clinical audit, staff feedback, research and other sources- to make shared decision-making a reality
p7

Further detail on our information, evaluation and evidence strategy for public health will be set out in the Public Health White Paper due later in 2010.
p27

A Quality Account is an annual report to the public from providers of NHS healthcare about the quality and outcomes of their services. It allows managers, clinicians and staff to demonstrate their commitment to continuous, evidence-based quality improvement. The first Quality Accounts have been published, covering providers of acute NHS services. Following the evaluation of the current pilots, we will consider extending them to other sectors. We are exploring how this approach could be applied to providers of care and support services.
p29

The use of evidence
4.6 In order to grasp the opportunities offered by the information revolution, clinicians and care professionals need to be able to access the best evidence (including international evidence) of outcomes, interventions and risks. Evidence needs to be user-friendly, up-to-date and available at the point of care, to inform discussions with patients and service users. Evidence is increasingly available in many forms, such as decision support, diagnostic interpretation, alerts such as those relating to drug doses and interactions and evaluation of therapeutic options. Individual professionals, teams and organisations need to be supported to access information of this kind, which can make all the difference in ensuring safety and effective outcomes.

4.7 Clinical and other staff need to use data to help improve the services they deliver and address inequalities, particularly in the outcomes of care. As the information strategy develops, it will need to take account of existing good practice in developing and using quality indicators as the bedrock of robust quality measurement. Such indicators should address key aspects of patient pathways including, where appropriate, looking at how efficiently services are being delivered. It will also be important to build on the Indicators for Quality Improvement library and other resources held by the Health and Social Care Information Centre (the Information Centre), by regional Quality Observatories, by other commercial data providers and by the Social Care Institute for Excellence (SCIE).

NHS Evidence is an on-line portal provided by the National Institute of Health and Clinical Excellence (NICE) that empowers staff with national and international best evidence and best practice information. The evidence is quality assured and made available both in its original form and through guidelines, pathways, tools and other resources. As NHS Evidence is expanded and developed all NHS staff, and others, will have free access to authoritative clinical and non-clinical evidence and best practice – available to support discussions and decisions at the point of care – as well as informing strategic planning and commissioning. It is an important addition to commercially provided data services (which are often subscription-based and aimed at particular specialist audiences). We intend to continue expanding and improving this service.
p36/37

Q25: As a clinician or care professional, how easy is it for you to find the evidence you need to offer the best possible care and advice? What could be done better?
Q26: Clinicians, practitioners, care professionals, managers and other service provider staff will be expected to record more data and evidence electronically. How can this be facilitated and encouraged? What will be the benefits for staff and what would encourage staff to reap these benefits?
p38

We see the evidence of the transformative power of digital technology all around us. To take just one example, the extraordinary growth of social networking websites in recent years is altering how people interact and sustain relationships, and in ways that were not foreseen, even by the pioneers of the sector. While health and care services have made great strides in adapting new technology to improve outcomes for service users, there is widespread consensus that there is scope to go much further
p49

Case studies / Local service profile examples mapping to this driver:
None as of 30/11/10

Date last updated:
30/11/10

Due for review: March 2011

Group member responsible: TO