NHS AYRSHIRE AND ARRAN
LIBRARY AND KNOWLEDGE SERVICES
A STRATEGY FOR 21ST CENTURY SERVICE DELIVERY
2004 -2006
“Knowledge is the enemy of disease”
FINAL DRAFT
Mhairi McMillan; Library strategy Co-ordinator 27/2/04
CONTENTS
1. INTRODUCTION 3
2. BACKGROUND 3
2.1 The Knowledge management context
2.2 Definition of service
3. THE NHS POLICY CONTEXT 4
4. NATIONAL DEVELOPMENTS 5
5. THE STRATEGY DEVELOPMENT PROCESS IN AYRSHIRE AND ARRAN 5
5.1 Where are we now? The Local Picture
5.2 Aim, vision and values
6. NEEDS ASSESSMENT 8
7. KEY AREAS FOR SERVICES DEVELOPMENT 9
8. HOW DO WE GET THERE? 10
9. OBJECTIVES 10
10. REFERENCES 21
11. APPENDICES 22
Appendix 1 Members of Stakeholders Group
Members of Knowledge Group
Appendix 2 Copy of the Questionnaire
Appendix 3 Copy of the Final Report from AMRC Ltd
Appendix 4 Qualitative Needs Analysis - Methodology
1. INTRODUCTION
The purpose of this document is to provide a framework for the development and delivery of a unified library and information service for NHS Ayrshire & Arran. It provides a broad outline for the modernisation of library information services for the period 2004-2006.
Section one provides background in terms of the wider context within which library and knowledge services operate. Section two deals with the developments within NHSScotland that have impact on the service. Following on from this the current local situation is described. The user engagement process and its findings are then detailed. Finally a set of objectives refined from the results of the user needs analysis are presented along with an over-arching set of recommendations concerning the future placement of the service within a unified management structure for NHS Ayrshire & Arran.
2. BACKGROUND
2.1 THE KNOWLEDGE MANAGEMENT CONTEXT
In recent years many organisations have started to recognise that knowledge is a vital asset, contributing to their success and future development. Knowledge management has been defined as:
“The systematic process by which knowledge needed for an organisation to succeed is created, captured and leveraged.” (1)
In today’s NHS the traditional view of librarians as custodians of collections of books and journals is therefore no longer appropriate. Rather, they are managers who facilitate the knowledge development process. They use their expertise and knowledge of the environment to anticipate and reflect user needs, select appropriate resources and produce information. The librarian is a qualified information professional, skilled in identifying a wide range of resources and designing and delivering a suite of information services. Librarians support improved patient care by providing the information that staff and students need for clinical and managerial decision-making, evidence based practice, lifelong learning and research and development. They deliver services across organisational and departmental boundaries working closely with partners in other NHS bodies, local government, higher education and voluntary organisations.
2.2 DEFINITION: LIBRARY AND KNOWLEDGE SERVICES
Therefore, with reference to the above, the term Library and Knowledge services is used throughout this document to represent the following dimensions, which also clearly involve close partnership working with IT, research and development and training and education departments within NHS Ayrshire & Arran.
q Services, skills and resources to support practice and lifelong learning in the healthcare workforce;
q Retrieval and appraisal of evidence to support clinical and managerial decision- making;
q Retrieval , appraisal and dissemination of evidence to support policy formulation;
q Support for the health information needs of patients and the public;
q Keeping the health workforce up to date with developments in research, evidence and policy changes;
q Management of internal, organisational knowledge; and
q Facilitating the translation of evidence into practice
3. THE NHS POLICY CONTEXT
Effective utilisation of the knowledge base of healthcare is now recognised as an intrinsic requirement within core government policy on health service management. ‘Designed to Care’ (2) and ‘Our National Health’ (3) emphasise the need to adopt an evidence-based approach in delivering best practice to improve the quality of patient care in Scotland. Therefore clinical and educational governance both depend upon NHS staff having access to, and training in, the effective use of published knowledge.
Historically however, provision of library and knowledge services to NHSScotland has been fragmented and uneven. ‘Learning Together’ (4) laid the foundations for improvement by requiring that by the end of 2004 all staff groups in NHSScotland should have access to library and knowledge services designed and resourced to meet their needs. ‘Learning Together’ emphasised that provision should cover all staff groups not only those in clinical areas.
HDL 2000(1) Learning Together and CRAG: Learning Resources and the Knowledge Base for Healthcare (5) built upon the above principle stating explicitly the need for national policy and at the same time charging boards at a local level to develop plans for library service development which reflect the priorities established in national policy.
At a national level the aim of strategic planning for NHSScotland Library and Knowledge services is to provide information and learning support throughout all stages of the patient journey; ensuring a consistent focus on patient need through the service development process.
The patient journey is broadly defined as:
q The “promoting wellness” stage , where support for public health, health policy and health promotion are the major concerns;
q Encounter with the NHS, via emergency services or primary care;
q The acute hospital stay;
q Discharge follow-up and rehabilitation; and
q Palliative care. (6)
The following principles that govern service development arise directly from this model:
q Equity of access to the knowledge base of health care and equity of accompanying support, independent of geography, sector, discipline or staff category;
q A unified approach to service provision;
q Access to information support at all times and at point of need;
q Proactive outreach to community settings, peripatetic staff and remote and rural areas;
q Recognition of the social as well as the medical model of care and the redefining of the NHS as a public health organisation; and
q Partnership working reflecting the cross-sectoral and cross-boundary nature of user need.
The White Paper ‘Partnership for Care’ (7) was published in 2003 heralding the move to single system working. This provided the opportunity to take a more radical approach to service redesign by looking for the first time at providing a unified Ayrshire-wide service based on provision at point of need for the user.
4. NATIONAL DEVELOPMENTS
NHS Education for Scotland (NES) has been charged with leading on library and information services at a national level. A national co-ordinator has been appointed who, in conjunction with a national Steering Group, has completed a framework for Library and Knowledge Services Development (8), at the same time as supporting efforts to build an integrated local service plan in each Board area.
NES has also been developing learning resources throughout Scotland in order to meet the needs of all staff in the NHS. The major innovation has been the establishment of the NHS Scotland e-library. This is an electronic library of full text journals, textbooks, core databases and reference sources.
Initially clinically focused, the e-library now aims to meet the needs of staff in pharmacy, social work, facilities and administration by providing access to over 20 databases, 200 e-books, c.4000 e-journals and range of additional free health information websites.
The challenge for Boards therefore is twofold:
1. To develop the local information practitioner workforce, together with local service management structures i.e. training, outreach and evaluation to ensure that these valuable resources are used effectively in supporting the delivery of quality patient care; and
2. To ensure that local service provision builds on national core developments and is tailored and delivered to best support the daily practice and learning needs of staff, regardless of their location or job function.
5. THE STRATEGY DEVELOPMENT PROCESS IN AYRSHIRE
Librarians in Ayrshire were keen to take up the challenge of modernising and improving Library and Knowledge services as outlined above and began by submitting a position paper to the Chief Executives to gain their approval to proceed with service redesign.
NES developed a planned structure to enable support for library service development at both national and local level. A national Steering Group was set up with senior management representation from each NHS Board . This role was taken up locally by Kirsten Major, Director of Health Policy who provided support at board level for the proposals for library and knowledge services development.
A library strategy co-ordinator (Mhairi McMillan) was nominated from within the librarians group to project manage the process at a local level and work closely with the National co-ordinator and the local Steering Group representative to produce the local strategy.
Having put this structure in place the librarians group met with Kirsten Major to draw up an action plan and timetable for the development of an Ayrshire-wide Library & Knowledge Services Strategy. User involvement was envisaged from the beginning and two groups were set up to ensure this was achieved.
The Stakeholder Group, drawn from a broad spectrum of users and partners, provided advice on the strategic direction for library services and will review and ratify the final strategy while at the same time, promoting understanding for service development within their own constituencies.
The Knowledge Group, drawn from local service providers, has supported the library strategy co-ordinator by working together to achieve consensus on priorities and objectives to carry forward strategy development (see Appendix 1 for membership of groups).
5.1 WHERE ARE WE NOW? THE LOCAL PICTURE
Libraries in NHS Ayrshire, together, currently provide resources to support the evidence-based practice, research and development needs and continuous professional education requirements of health service staff. The libraries also support the education of students on placements and provide varying levels of information for patients. The core services of borrowing, journals, inter-library loans, literature searching, access to databases, access to the internet, current awareness services, photocopying facilities and user education are common to all.
The service is at present delivered on 4 sites. The librarians in charge are graduate/chartered professionals with specialist knowledge gained through training and experience.
q Acute hospitals trust librarians specialising in clinical services.
q Primary care trust librarian in mental health and primary care services.
q NHS Board librarian in public health and healthcare management.
Each librarian is responsible for service management and development in their area through:
q Planning , co-ordinating and managing learning resources;
q Training others to access resources; and
q Evaluating current provision and developing services to meet the needs of their users.
The librarians also provide a value-added service to users in terms of skill levels in information retrieval. Providing, where necessary, fully appraised and reviewed literature to support evidence based practice.
While the individual librarians endeavour to co-operate and work together, further innovation and integration is difficult to achieve where there is a lack of coherent structure across the service. At present job descriptions, and grading of librarians differ as do management structures, staffing and budget levels. Opening times and user rights and privileges also vary across the libraries leading to lack of cohesion and fairness in the system.
The librarians conducted a review of current strengths and weaknesses. The SWOT analysis below outlines the detail of the current situation and the opportunities for improvement.
STRENGTHS· Well-established, widely used services· Good co-operation among the individual services
· Supported by national resources
· Accredited learning centre status achieved in the acute trust setting
· Links with universities through students and Postgraduate Medical Education· Links with other library networks through
Ayrshire libraries Forum
NHS Education Scotland
Scottish Health Information Network
Scottish Library and Information Council / WEAKNESSES· Inequality of access for users depending on job function and location
· Access problems experienced by users in rural areas
· Limited support staffing meaning librarians carrying out a significant range of administrative duties, allowing little time for professional development
· Inequality in provision of IT infrastructure and support on which access to electronic resources is dependent
· Diversity of policies and user rights in each library resulting in inequality across the system as whole
OPPORTUNITIES· Create an Ayrshire wide service promoting access for all at the point of need
· Contribute to the develop an information-literate, research based, learning culture in the workplace
· Improve resources to support the “patient journey model”
· Gain Board level support for a professional service that is adequately funded and supported with the appropriate management structure
· Have knowledge service needs addressed in the IM&T strategy – as developments need to be supported by sound IT infrastructure
· Develop quality standards for an Ayrshire wide service and harmonise policy / THREATS· Level of funding
· Degree of support from senior management to achieve change
· Staffing levels
· Level of IT support
The Stakeholder Group reflected on this exercise conducted by the librarians and established a clear vision and set of values upon which to base the development of a strategy for a unified library service for NHS Ayrshire & Arran, detailed in section 5.2.
5.2 AIMS, VISIONS AND VALUES
Aim
· To deliver a unified service that meets the information needs of the healthcare community equitably, by providing access to high quality information resources.
Vision
· To deliver an integrated, equitable and proactive library service at point of need. This will enable users to obtain the knowledge and evidence they require to support their practice, professional development and information needs.
Values
· To provide quality current information to improve healthcare in Ayrshire & Arran.
· To support equitable access to the knowledge base of healthcare.
· To strive constantly to provide the highest quality service based on service review and audit in consultation with service users.
6. NEEDS ASSESSMENT
In order to create a single service that would be fit for purpose however it was recognised that a formal analysis of users needs was necessary to consolidate the initial SWOT analysis. It was agreed that the user needs analysis be a twofold process.