Saturday, 30 October 2010

A busy October

It has been a very busy few weeks here in the Healthcare Library and I thought I would take a bit of time to reflect on a few things that have happened in the past weeks. My colleague and I did a session at another site hospital last week on critical appraisal, covering both quantitative and qualitative research (she did quan, I did qual) and it went really well! All the participants turned up, which is very unusual, and there was a good mix of doctors, nurses and allied health professionals.

I piloted an exercise found on the ever helpful CATNiP wiki called the “Qualitytative Street exercise” which basically used Quality Street chocolates to explain some of the concepts of qualitative research. Basically everyone had to choose their favourite, eat it then describe what they liked about the chocolate. These terms were written up on the whiteboard and then we put them into categories such as ‘taste’, ‘texture’ or ‘appearance’. We then had a discussion on such issues as focus group recruitment (e.g. nobody asked what the study was about before agreeing to participate!), why people might choose not to take part, how the data were “collected”, data saturation, how the data were analysed and the role of the researcher (how might their answers have differed if they knew I was employed by Nestle...or Cadbury’s?!) We got very positive feedback on the session overall and a few people mentioned they found the qualitative session particularly useful as they do not encounter much in their day-to-day work. I personally found listening to the quantitative session very helpful as it gave me ideas for what to add to my training course.

Our journal survey finished at the beginning of October but between one thing and another I didn’t get a chance to look through the results properly until Friday, when I had to send the results to my manager and the manager on our other site for a meeting on Tuesday about journal selection for the coming year. We had 151 responses in the end and it was very interesting going through the results. We received a lot of useful suggestions for how we could improve the service as well as a huge list of recommended journal titles. I do not envy the managers trying to decide which ones to take and which ones to discard! One very positive result was seeing how well the NHS resources are used – the majority of respondents said they used, HILO or MyAthens to access e-journals. The next favourite access point is Google which is not surprising really. Another interesting result was that only half of the respondents prefer electronic access to journals over print. 18% prefer print and 27% have no preference. The respondents seemed fairly satisfied with the provision of e-journals and print journals, ease of access and promotion and the top titles read at the Trust are BMJ, New England Journal of Medicine, Lancet, Nursing Standard, British Journal of Midwifery and Stroke. Some of the suggestions for improvement were a bit outrageous, such as having print copies of all journals at all three sites (exactly what we are trying to avoid!) and “electronic access via British Library services” (which if left to the devices of our users would wipe out our entire budget in a week) but others were very helpful such as targeted email services for specific subjects and coming to speak at team meetings and inductions. The survey certainly identified areas where further training is needed.

Finally I have been working away on my very first book review! An email went round a few weeks ago asking for volunteers to review a couple of books for the HLG newsletter. My manager forwarded it on to me and one of the books “Technology Training in Libraries” caught my attention so I got in touch with the person offering and volunteered to do the review. The book is part of the Facet ‘Tech Set’ series and was a very interesting read. I enjoyed the experience of writing up about it and will put the link to my review when it is published in the newsletter, hopefully next month.

I have been very busy with one-to-one sessions, especially as degree courses are starting up again. I had an Orthopaedics registrar in the other morning who wanted a very comprehensive literature search for his dissertation and I was grateful once again that a Masters degree is required for becoming a qualified librarian as the first thing he asked was whether I had experience in carrying out research. If I hadn’t done a Masters and gone through the experience of carrying out my research project I probably would have felt quite intimidated but as it was I could answer in the affirmative and he seemed quite impressed that a postgrad qualification was required for being a librarian!

Sunday, 24 October 2010

An Information Revolution...without libraries?

The Department of Health’s Liberating the NHS: An Information Revolution consultation document was published on Monday this week (18 Oct 2010) and lays out a strategy for the way the NHS should manage information in the future. As Andrew Lansley quite rightly states in the Foreward of the document, “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” (p3). All well and good but the term “information” in this document is somewhat nebulous, used as an umbrella term for everything from patient records to health websites to audit to evidence. Furthermore there is no mention of libraries or library services anywhere in the document apart from a reference to the “Indicators for Quality Improvement library” (p36) which I for one have never heard of.

While the bulk of An Information Revolution is concerned with patient records and the flow of medical data there are certainly a number of areas where libraries are involved or could be involved. Section 4.6 states “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…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” (p36) Ummm, yes – do they not realise that this information is already being provided by hundreds of NHS medical libraries across the country every day? There is a short paragraph dedicated to NHS Evidence, described as a service which “is an important addition to commercially provided data services (which are often subscription-based and aimed at particular specialist audiences)” again ignoring the fact that such subscriptions are usually paid for by NHS library services on behalf of their users.

The document strongly supports better access to medical information for patients, which of course is laudable, but takes a rather simplistic view of what is a very complex subject. The emphasis on the internet as a channel for medical information is very obvious but is fairly silent on the subject of information literacy and evidence-based medicine. The three criteria for effective information is that it should be:
- informing, so that they know it is comprehensive and can be trusted;
- engaging, so that they are willing and able to use it; and
- empowering, so that they know how it can make a difference (p11)

How about authoritative, evidence-based, reliable?

The document states that “for some time now, people have been using the internet to explore a diagnosis after (or before) they visit their doctor” (p10) quoting a study of patient use of the internet which showed 11% of patients for neurology outpatients at the Walton Centre for Neurology and Neurosurgery in Liverpool in 2001-5 accessing the internet prior to clinic attendance. 11%?! It’s hardly statistically significant is it? The document also mentions “the role of websites such as ‘Mumsnet’ in generating new ways of sharing insights and information – including health information – is having a lasting effect on our society. Carers, patients, service users, care workers and clinicians are increasingly able to access forums to discuss the issues that matter to them, and offer support from others with experience of their condition” (p10) and exhorts that “the NHS, local authorities and care providers should be responding to and supporting these new approaches” (p11). Now I have been on a few of these forums in my time and have found them pretty useless to be honest, mainly involving somebody complaining they have a strange rash, followed by a slew of respondents all saying they have something similar but nobody knowing exactly what it is or how it should be treated.

Libraries, both medical and public, are extremely well-placed to provide authoritative, reliable information to patients. Many libraries already do and even more would be willing to do so. Why is this not mentioned in An Information Revolution? It may well be that “information cannot be seen as something that is the sole responsibility of the specialist” (p39) but why not harness the knowledge and experience of information specialists such as librarians and avoid reinventing the proverbial wheel?

Finally, I did have to laugh at the statement on page 14: “Whilst any associated costs will need to be met within the Department of Health’s Spending Review settlement, there will be no additional central funding to pay for the information revolution…Whilst there will inevitably be costs, which could fall centrally and/or locally, the information revolution should, ultimately, pay for itself.” Not surprising really that the government thinks good quality information can be produced on the cheap, but it makes the whole document ring rather hollow.

I shall definitely be responding to this consultation document and hope many other medical librarians will as well. After all, there is not going to be an Information Revolution in the NHS without us!