LIHNN/HCLU Briefing June 2017

Knowledge for Healthcare: Business Critical – David Stewart

LIHNN AGM 2017

LIHNN Group Updates

The patient will see you now: a new era of empowered people living with health conditions – Simon R. Stones

Patient and Public Information Workshop – Prioritising PPI ideas – John Gale

The exercise John did on prioritising PPI ideas is available on the PPI section of the Knowledge for Healthcare blog under Resources – Workshop Materials

 

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Postcards from LIHNN – Group Updates for Summer 2017

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Evidence Summary and Synthesis: a Summary by Katie Nicholas

Evidence Summary and Synthesis: a Summary[1]

I hope I’m right in saying that when asked to ‘do a search’ for someone our default is usually to ask a few questions of the enquirer (if they haven’t already run away to get on with something else), jot down some key terms, quickly switch HDAS on and get on with formulating a strategy so that HDAS can generate a lovely list of references we can then email to whoever asked. We hope they appreciated it but they have since gone about their day and we’re left wondering if anyone ever opened the email – then the next search comes in and we start the process all over again…

I came into the Searching and Synthesis course from a slightly different perspective. The types of requests we receive from colleagues in HEE are less suited to this way of searching and the answers rarely come from HDAS. Quite often I start with Google to look for titbits in reports and board papers that, though lower down the ‘evidence hierarchy’, might just be what our enquirer is looking for. Going in I was anxious, I wasn’t sure I could do ‘proper searches’ using masterfully honed strategies that reaped endless systematic reviews and RCTs. And, after I’d struggled through the search, would I be able to ‘take a breath’ as John suggested[2],  and actually look at the results and paint some form of coherent picture of what they found?

The first session helped me think about how I organise the results I find as I’m searching. I think most of those who attended found the ‘table tool’ useful. It seems simple but organising results into a matrix detailing citation information and notes from the abstract really did help me organise my thoughts. You can download results from HDAS into Word or Excel but they are not tidily arranged so if you’re doing this factor in time for cleaning up the results. This of course takes longer if the results cannot be downloaded from HDAS as they have been plucked from all over the web – something I raised in the last follow up session. However, on the whole I found this a really helpful way to organise my results and prepare them for the second phase –summary/ synthesis.

The second session felt like much more familiar ground, we looked at other useful sources where commissioners/ managers might expect the answers to be (the Health Foundation, the King’s Fund or the HSJ for news updates).

However, it was the follow-up sessions (three half mornings, plus a mailing list) where I think I gained the most practical experience and where the most ideas were shared. Each session had an accompanying practical exercise that we could all have a go at then talk about at the session. The exercises were stepped;

  • in the first we were given a set of results and asked to ‘write a review’
  • in the second we were again a set of results to review but, to make it a little harder, the results had contradictory findings so we had to be more inventive in our write up
  • and finally we were given a query and had to do the search and write the review.

I gained a lot from this opportunity, because we all conducted the same search and compared reviews in the follow up sessions there was an element of peer-review it is normally hard to achieve. Seeing how others had gone about theming and presenting results was for me the most helpful part of the course.

I did think we missed an opportunity to do what I’m coining a “HDASless search” and review though –if the evidence managers and commissioners need to make decisions is not always found in the databases it would’ve been nice to have a go at a review where the results couldn’t really be organised by level of evidence, or that were from disparate sources with no abstracts.[i] These results inevitably take longer to summarise and a bit of digging might be required to really pick out the useful bits. I think going forward this is something that we should revisit if we’re going to have an impact from ‘bedside to boardroom’.

The general consensus from the groups I attended was:

  • This isn’t appropriate for all searches or for everyone who has a query (a bit a judgment on our part is needed to select the occasions where this could be impactful and add value)
  • Putting the reviews together is incredibly time consuming (the last search and review took at least 8 hours, others in the group reported longer). I’m sure we’d get a bit quicker with practice but this re-enforces the first point about it not being realistic for every search
  • This process definitely hones our skills – it encourages us to actually get to grips with the material and put our synthesis hats on to create a useful, brief review
  • The results were aesthetically pleasing – people used tables, headings, colour(!) and everyone agreed it made for a much nicer final result that could be packaged and branded as a LKS ‘product’

We also had some discussions about who the audience for reviews would be and decided that that would be entirely dependent on the organisation. We would each know best when, and for whom, these reviews could work. In the last activity it was easy to forget who the audience was and what they were actually asking. I struggled to get to grips with the final search question and lots of us reinforced the importance of the ‘reference interview’ in a real search scenario. After all this is not Line of Duty – we need not be ‘one rank senior’ to probe a little further to uncover what our colleague really wants to know, rather than what they originally asked for when they collared us in the corridor.

Some other questions the feedback sessions raised?

  • How important are levels of evidence? They are obviously important, but how important are they in this scenario? It’s possible we’re dismissing, or not paying enough attention to, potentially useful results because they’re at the wrong end of the trusty evidence pyramid
  • Where does critical appraisal fit into all this? The reviews take so long it may be necessary to push the critical appraisal ball back into the courts of health professionals or at least make it clear we have not appraised the material
  • Just what is the difference between synthesis and summary? I’m not sure we really had an answer for this. I’m proposing 42.
  • Is there any merit to shared searching and reviewing? There could be scope in tackling searches together to get a higher quality, almost peer-reviewed, final product
  • How do embed this into practice? Is it realistic to embed this into practice? I think the answer to this will depend on each team; their capacity to deliver this to their members and their belief that it will add value to their service offer
  • What are the next steps? There may be a way we can all re-group and have another practice to maintain the skills and keep the discussion going through the already existing Clinical Librarians’ group
  • How do we better distribute these summaries? We need to think about duplication of work and remember the ‘do once and share’ motto if we are going to invest so much resource into this
  • How do we overcome our insecurities as non-clinical folk? I think after an early crisis of confidence I came to the conclusion that I could only review the information in front of me, in the words it was written. Transparency is key – we can only be clear about what we’ve done, or not done (i.e. critical appraisal), ultimately it is for the health professional to unpick what the evidence means in practice
  • How do we tackle those HDASless searches and reviews? It’s hard for me to ignore the wealth of resources that are not housed in the databases that could enrich these reviews, even if they do muddy the waters and make them trickier to do

For me the course was a good start to what I’m sure will be an ongoing conversation about this and I look forward to hearing from the other synthesisers (thanks John). The mailing list (reviewing_practice_north@libraryservices.nhs.uk) is a good place to start  There have already been some interesting discussions about RAG ratings, disclaimers, critical appraisal and how best to tackle these reviews so why not join the conversation and share some of your thoughts and tips?

 

Katie Nicholas
Knowledge Officer
Health Education England, working across the North West

[1] Or is it Synthesis?

[2] John Gale’s blog about the course https://lihnnclinicallibs.wordpress.com/2017/05/12/evidence-synthesis-going-beyond-the-reference-list-by-john-gale/

[i] Anne Gray shared an interesting article about commissioners and the evidence they’re looking for: https://www.nihr.ac.uk/blogs/evidence-based-policy-making-the-view-from-a-commissioner/6045

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Scholarly summer reads by Helen Kiely and Lorna Dawson

If you’re thinking of doing the MLIS, Helen and Lorna give you a head start with their top texts to read for the course.

 

Lorna:

Formulating the Evidence Based Practice Question: A Review of the Frameworks by Karen Sue Davies

Evidence Based Library and Information Practice (2011) vol 6. Iss. 2 75-80

This is the article I wish I’d read in the first few weeks of the course. We had a group project to undertake a mini systematic review. The entire project was conducted through enquiry based learning so no lectures, all discovering the steps for ourselves. One of the decisions was to decide what framework to use to frame our research question and this article would have been perfect for helping us make that decision. Davies identifies 10 different questions frameworks including PICO, ECLIPSE and SPICE but also several variations. She breaks down the elements of each framework, and identifies the specific context within which that framework is most appropriate for example ECLIPSE was designed to address questions on health policy and management.

 

 

Developing skills of reflection by Birmingham City University

http://library.bcu.ac.uk/learner/Study%20Skills%20Guides/7%20Reflection.htm

 

Beginning reflective practice by Melanie Jasper

I must admit, I didn’t use a full blown text book to do the reflective parts of our assignments. I used this study skills page because it described really simply and clearly what was needed in reflection: the experience, how you felt about it and an evaluation of it. Some people might feel more confident using a book with frameworks to aid reflection and my fellow coursemates recommended Melanie Jasper’s Beginning Reflective Practice. With simple exercises and diagrams, this was a really good introduction to reflection for them. Whatever you prefer, my main point is to familiarise yourself with the process of reflection because you’re going to have to do it at some point on the course. Not many people enjoy it but I find it really beneficial. I tend to discover I learnt more than I thought, and I find it useful to think about what I’d do differently next time.

 

Written evidence submitted by InformAll and the CILIP Information Literacy Group (FNW0079) by Stéphane Goldstein, Dr Jane Secker, Dr Emma Coonan, Dr Geoff Walton

http://data.parliament.uk/writtenevidence/committeeevidence.svc/evidencedocument/culture-media-and-sport-committee/fake-news/written/48215.html#_ftnref6

This article was actually co-written by one of my lecturers on the course. It responds to the “post-truth” or “evidence-averse” era we’re currently living in and suggests ways we can educate people in how to appraise news and information. The article argues that people need to develop their own ‘cognitive firewalls’ and actively evaluate the information they are confronted with. A key player in the development of this mindset is teaching critical thinking skills in secondary school. I found this article important because as librarians, we are in a natural position to support people becoming more information savvy. It also made me realise that there is a political side to what we do and what libraries stand for, which is not something you really expect when you go into the course.

 

Exploring Strategy by Gerry Johnson

Johnson’s ‘Exploring Strategy’ was a great starting place if you’re researching strategy. There are so many strategy theories out there and Johnson gives a really good overview of some of the key ones. He then walks you through the main aspects that need to be included/considered in a strategy and provides a nice strategy checklist at the end of one of the chapters. It has a very textbook feel which is helpful and reassuring if it’s a topic you’re kind of coming to by yourself. It’s not really written with libraries in mind, more large for-profit organisations. This doesn’t mean the theory can’t be applied but bear in mind that some bits won’t be relevant or may need to be interpreted in a slightly different way. It’s also always useful to get perspectives from other texts but this is a really good place to start.

 

Organisational quality and organisational change: Interconnecting paths to effectiveness by Ian Smith

Library Management (2011) vol 32. Iss. 1/2 111-128

One of the topics I found really interesting and which I think will always be relevant to libraries was organisational change. There are lots of different models of how change takes place. Smith’s paper discusses two – Kotter’s and Doppelt’s – and I found it really useful to see the similarities and differences in the two. Smith then uses these two models as frameworks through which to consider a case study which helps you see the theory in context. The thing I learnt most from this paper was the need to have an organisational mindset that was receptive to change. This is so relevant to us as the roles of librarians are constantly changing and we need as a profession to be willing to embrace the new.

 

Helen:

Theory and Practice of Leadership by Roger Gill

One of my current core modules is Leadership, Strategy and Change and this book has been absolutely terrific for me. Gill explains the differing theories that have developed over the years simply and yet thoroughly enough to give me a good understanding- after starting with several other texts which were rather more philosophical in their outlook it was a relief to read one that brought everything together. As you might expect I was reading quite specifically at the time for an assignment, but I would certainly go back to this book for any further help I might need on the topic and would definitely recommend it.

 

The Impact of clinical librarian services on patients and health care organisations by Alison Brettle, Clare Payne & Michelle Maden

Health Information & Libraries Journal (2016) vol 33. Iss. 2 100-120

I hope it isn’t a ‘cheat’ mentioning an article I’m sure the vast majority have already read, but truthfully I have referenced this in so many of my assignments this year, and referred back to it. It really is a key study about measuring impact and ways in which this has been done so far, and is a really important article for the direction of travel within libraries for the future.

 

Managing your Library’s Social Media Channels by David Lee King

This book isn’t from a health library perspective, but I have been finding it extremely helpful nonetheless, mired as I am in a current assignment about social media tools and marketing. It has given me a lot of ideas and I will definitely be picking it up again post-assignment. Whilst not all of King’s ideas necessarily translate, he highlights a lot of important points about the use of social media by libraries, particularly with regards to using it to encourage more interactivity from users – inviting and responding to queries etc- and embedding the service within the community through tone and user-engagement.

 

Time to rethink the role of the library in educating doctors: driving information literacy in the clinical environment by Mary R. Simons, Michael Kerin Morgan, Andrew Stewart Davidson

Journal of the Medical Library Association (2012) vol. 100 iss. 4 p. 291-296

Although probably a little old now I used this article, among others, as part of our information literacy assignment and this one had a lot of ideas about the relationship between the medical profession and information literacy. Put simply, although 1:1 sessions and one-off teaching are incredibly useful, there is a concern within the literature of this topic that the training is not entirely retained. Although the case study given in this is quite niche (it focuses on one small speciality in a hospital attached to a university) it looks at other ways of incorporating search skills and information literacy training into a clinical team.

 

Queering the Catalogue: Queer theory and the politics of Correction by Emily Drabinski

Library Quarterly (2013) vol. 83 iss. 2 p. 94-111

Finally, this is an article that is less about direct use and more ‘a bit of fun’- well for me at least. It discusses the use of cataloguing and how categorisation is affected by social and political moods, and how these have changed overtime using examples from the Library of Congress. It appealed to me because it explores the changeability of language and social concepts of ‘normality’ and what language is acceptable, and really helped me at the start of my studies in terms of helping tie in and relate to my previous studies and academic interests in an accessible way.

Lorna Dawson and Helen Kiely

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Evidence synthesis – going beyond the reference list by John Gale

Doing literature searches for people can feel a little bit like working a sausage machine. We shovel search terms in one end, wait for HDAS to do its magic and then shovel the resulting list of references back to the reader. Often we don’t engage with the material at all beyond weeding out articles in foreign languages or filtering out the systematic reviews.

Evidence synthesis is a different approach. It means taking a deep breath and plunging in to the material, sorting it, getting to grips with it and attempting to provide a structured response for the end user. Over the course of our sessions on evidence synthesis it became apparent that there are almost as many ways of doing this as there are librarians. Some preferred to use a framework, exporting the results into an Excel spreadsheet, rating them for quality and providing a structured response in the form of a table. Others preferred to use a more narrative approach, seeing what story – if anything – emerged from the research and attempting to tell this with the references at the end. Perhaps there’s no right or wrong way – although if we do it in a way we feel more comfortable with and enjoy using I would argue that would lead to a better end product.

Subjects that are amenable to being searched on HDAS make life a lot easier. You can round up all your references in one Word document and – if you’re lucky enough to have access to a bibliographic software package – export them into EndNote or something similar. I was very old-school and actually used pen and paper to make notes on the articles. I found it slowed me down enough to start thinking about the topic and while I was writing my mind was mulling everything over – something I don’t find occurs when I’m just cutting and pasting. At that point it struck me that compiling a narrative evidence synthesis wasn’t that dissimilar to doing an essay at college albeit with COPD and health literacy taking the place of crime in the nineteenth century. As it happened, in this particular instance, the research told a clear story which very much lent itself to a narrative approach but this might not always be the case. For more ‘on the one hand, on the other hand,’ results it might be an idea to group studies by whether they favoured the particular treatment being studied or not, or by the outcomes they measured; both of which allow us to indulge our inner Lawrence Llewellyn-Bowen and do a bit of colour coding, at least in a digital format.

All this takes time of course. If I’d been more pressed I’m sure I’d have made more use of cutting and pasting and foregone my pen and notebook and searches can, of course, expand and contract to fill the time available. However, I suspect few of us will ever end up in the Goldilocks zone of having just enough searches to do a thorough evidence synthesis for each one. In my experience it’s easy to tell which searches are for presentations or journal clubs – “have you got anything, anything at all, on x,y or z”- and searches made for more clinical reasons but even then that might leave us with too much on our plates. There is a real risk that we raise expectations by doing Rolls-Royce searches when we’ve got time only to find we’ve only got enough time to knock up a Morris Minor when we’ve got half-a-dozen to get through at the same time. However, I don’t think this is an adequate reason for not doing them. We’re hoping to share our evidence syntheses where people have given permission for their search results to be shared and it would be great to have a central repository somewhere on the old ‘do once and share’ approach. There’s now a mailing list set up for evidence synthesisers at reviewing_practice_north@libraryservices.nhs.uk so why not chip in with your own thoughts, share your reviews and pass on a few tips?

John Gale
Trust Librarian
Mid Cheshire Hospitals NHS Foundation Trust

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NHS Health Care Libraries Supporting Research by Matt Holland and Victoria Treadway

Research is firmly embedded in the NHS Mandate 2017 – 2018 (see Objective 8 “To support research, innovation and growth”). It probably didn’t need a directive to point out the importance of research to patients and patient care. Research is also core business for NHS libraries. This is a reflection on how we can make research a distinctive part of our service offering. It’s based on personal experience and best practice using the tried and tested ‘n things’ model.

  1. Go to the Research Committee It’s a safe bet that no one ends their career wishing they had gone to more meetings. However, in something as diverse as research in a large organisation the Research Committee can be the best place to get an overview of current and new research activity. If you are not on the committee as a member, you could ask to be an observer or to be circulated the minutes.
  2. Collaborate with your Research Department If you can make friends with your nearby Research Department team there are opportunities to collaborate on events or projects to make life a little easier (and fun?) for your organisation’s researchers. Mid Cheshire are planning a Research Expo for June and Wirral are coordinating a Randomsied Chocolate Trial to celebrate this year’s International Clinical Trials Day (May 19).
  3. Host your organization’s publications database Creating a database exists at on a continuum starting with a quick and dirty solution using freemium reference software (Zotero / Mendeley) and ends with Institutional Repository. The library is the natural home for this project. It also contributes to Knowledge Management objective viz, connecting with corporate knowledge, mapping knowledge assets; collating and enabling shared access to directories; policies, guidance and protocols. Knowledge about the usefulness of a database or Institutional Repository will vary so it may just be a case of carpe diem or getting on with it.
  4. Be the source of information about the research landscape Make the library the centre for information about research methods, academic writing, training courses, support for research, regional and national organisations, newsletters, research information on social media. You could add this into your social media, current awareness mix or set up a separate space for researchers. (See NWAS LKS Case Study on using Yammer).
  5. Be the publications expert for your trust Publication isn’t as easy as it was. There are choices and decisions to be made. Choosing Open Access (Green/Gold), avoiding predatory publishers, fulfilling funding requirements, funding Article Publication Fees (APCs), navigating journal rankings, choosing appropriate journals, copyright, promoting your research and more. Being the expert and the place to go for information for help adds real value, especially for early career researchers.
  6. Offer researchers a bespoke service Clearly all our users are at heart researchers from the humble diploma to post doctoral students. Even if it doesn’t change the service you offer badging part of your service as for researchers can make promoting the library to the research community easier and give you a seat at the research table. This also fits with LQAF 5.3i Library/knowledge service staff support the research activities of the organisation[s] served.
  7. Develop your research skills Nothing helps you to understand the viewpoint of a researcher better than being one yourself. Opportunities for librarians to get involved in research are out there, and may vary from co-authoring a systematic review to getting to grips with qualitative research methodology (as did a bunch of clinical librarians from the NW not long ago).

Matt Holland, NWAS LKS and Victoria Treadway, Wirral University Teaching Hospital NHS Foundation Trust. NWAS LKS is supported by HCLU North.

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Reflections on Recent CPD by Rosalind McNally

I have recently taken advantage of one of the many benefits of CILIP membership through their online learning. The CV webinar I attended late one weekday evening was delivered by Alistair Morris www.cvandinterviewadvisors.co.uk

I cringed as Alistair brought me kicking and screaming into 21st century recruitment techniques. I looked down at my 6 page, tea stained, CV. No one is interested in that summer stock moving job you did at Manchester Polytechnic 25 years ago. The fact you like walking? No one cares.

It was explained that modern recruitment success relies on you aligning the key terms for the “Hot skills”, that is, the hard functional and technical skills of your professional role with those of the recruiter. Filtering of CVs or applications may well be done electronically or by a person under instruction to look for those key terms only. Knowing what these are is essential. Most Library staff in the health sector will be applying by application through the NHS Jobs website, but the approach needed will be the same.

What are our Hot Skills?

I considered what these are for an Outreach Librarian using the PKSB for Health and Knowledge for Healthcare. You can also look at job specifications as they are advertised to monitor this.

Further learning points were:

The way you see your CV should be the business case for you. At a career grade Band 5 Librarian on 25k that’s 125k+ over 3 years so you have to pitch to that and what will be the Return on Investment for the organisation, to have a chance of an interview

Try structuring your CV into sections with a concise Key Value Proposition of your key areas of expertise, career highlights and recent career history. These can then be more expansive in the individual sections, or be used within an application for a particular role.

You can use techniques like FAB (Feature and Benefit) for your Key Value Proposition, and STAR (Situation, Task, Action, Result) for your career highlights.

More traditional sections of the CV, that is, Career History, Earlier Career, Qualifications/CPD, Personal History, Recommendations, should all focus on achievements.

So where am I now? Having ditched that hobbies section I have drafted some FAB statements for me from my last 6 years, which I can use in meetings and to inform discussions as I am in 2 services integrating currently. I also feel more confident of my own value having spent time reflecting on what my achievements have been, which for all of us can get lost in the pace of modern working life.

Late night webinars may not suit everyone but I found it fit around my caring responsibilities, and you can also enjoy a glass of wine in the process. The company provides a commercial CV writing service and interview coaching and has some good free taster resources you can access from the site.

Rosalind McNally
Outreach Librarian
Greater Manchester Mental Health NHS Foundation Trust

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