HLG Conference, Belfast
Health Libraries Group Conference, Belfast, 6th-8th September 2004
Janice Grant
Introduction
I must first record my pride at being this year's recipient of the Hazel Williamson Bursary. Hazel was unfailingly patient and helpful to me when she was at Glasgow Royal Infirmary as I took my first faltering steps in setting up the library at Ayr. She was always cheerful and encouraging when I asked her advice. Her influence on health libraries in Scotland was immense. I hope I was able to uphold her memory in my contributions at Belfast.
This year's theme was Variety is the Spice of LIFE (Libraries and Information for Evidence). As always, discussion was around topical subjects, this year including evidence based librarianship; Knowledge Management (and how this differs from what we called Library and Information Science); the new roles we are increasingly embracing, such as those of clinical and outreach librarians; and inevitably Agenda for Change. In comparison with earlier conferences, this year emphasised the librarian in the clinical rather than educational context, and the need for us to seriously market and promote our services.
For those who have not yet attended a Health Libraries Group Conference, I hope to convey a flavour of what is always a valuable and stimulating experience. The image of 300 librarians descending on a city or campus may seem scary, but this is an opportunity to share experiences and ideas with colleagues from diverse backgrounds, and doing so at leisure rather than having to rush away from a day meeting. Apart from the formal programme, delegates can chat over coffee and lunch while viewing the trade exhibition and posters. The exhibitors are happy to discuss their products and services informally, and the poster presentations demonstrate the innovative work of our colleagues, including several Scottish projects.
The social programme this year included a cultural and historical visit to several of Belfast's pubs (seriously) and the conference dinner and civic reception in Belfast's City Hall - a splendid affair.
Conference The formal programme was a balanced mixture of keynote talks, plenary, parallel and interactive sessions. I will pick out a few examples of each to illustrate the variety of themes. Maggie Haines, the President of CILIP, encouraged us to grasp the opportunities of embracing new roles. We have known for some time that the traditional print-based library has disappeared. But 'new roles' we may have identified at the last conference have again changed. Technology and the NHS itself are in constant flux. We must ensure that when we become integral to Knowledge Management this is not just a new name for what we already do. We should promote ourselves as knowledge leaders within the framework of our organisation. Our (large and lively) Scottish contingent pricked up our ears when Maggie emphasised the importance of producing a good strategy, whether for a library service or HLG itself. She declared that a shining example to all is our own Scottish 'Exploiting the power of knowledge in NHS Scotland'!
I will return to the subject of our relatively fortunate situation in Scotland. On the final morning, the theme was the role of clinical librarians. T Scott Plutchak, of the University of Alabama, gave a witty if sobering talk, 'From Clinical Librarian to Informationist'. The clinical librarian studies and assesses the literature rather than provide a list of references. He referred to a seminal article in Internal Medicine, in July 2000, describing the role of the clinical librarian - an article which produced little response or encouragement from clinicians. In spite of serious efforts, the clinical librarian in the US remains marginal. A new development is the ISIC - Information Specialist in Context - and the specialist would not require to be a librarian. He left us feeling rather despondent, as he insisted that the traditional role of the health librarian has gone, and in general we do not have the right training for the new role. To be accepted, the Information Specialist would probably require to have excellent clinical knowledge. On the other hand, there is evidence that clinicians do not recognise a lack in their knowledge base or information seeking ability. As 'informationists' we must take on the huge task of convincing clinicians of the benefit of our skills.
Two presentations from the UK followed, looking at the clinical librarian in a practical setting. Steve Rose spoke of Helen Carter's work as clinical librarian in the emergency department in Oxford, where she established excellent co-operation between herself, the SpR's and SHO's in developing local clinical guidelines. This project, now complete, received positive feedback from the clinical staff. Attempts are now being made to develop the role to ensure equitable access throughout the Trust, possibly in a Research and Effectiveness post.
Claire Honeybourne, of the University Hospitals of Leicester NHS Trust, spoke of a trial in Leicester, 'Knowledge in the palm of your hands: PDA's in the clinical setting’. The project involved setting up a 'Drs Companion' where hand-held computers were issued to all doctors, GP's and specialist nurses. These were loaded with relevant resources, such as BNF. Oxford handbooks, anatomy, guidelines, medical dictionary. Thus at the bedside information can be checked as decisions are taken. The feedback was excellent, though drawbacks were cost, technical difficulties and low, sometimes trivial, usage in some cases. Leicester now has four clinical librarians, and the next stage is that all foundation doctors are issued with the Drs Companion, now including the junior doctors handbook. Thus as these doctors progress in their careers they will be accustomed to accessing required information by such means.
Between the plenary sessions were less formal Interactive and parallel sessions, where delegates chose from a variety of topics. The interactive sessions were hands-on meetings, where small groups worked on a practical topic, such as developing quality marketing resources. The parallel sessions usually had two or three speakers describing their experience round a specific theme. These were necessarily restricted by time, but were invariably so well led that the available time was used to full benefit.
A typical interactive session was 'Developing a template for assessing the effectiveness of information skill training’, where Alison Brettle and Joanne Greenhalgh of the University of Salford alerted us to the difficulties of assessing the effectiveness of our training. There is no ideal template, similarly little research has been published. We discussed the merits and pitfalls of questionnaires, practical exercises, skills checklists, timing of assessments. Our take-away message was that we should certainly try to assess our training, and must aim at specific outcomes measures. These should be valid; reliable; show responsiveness, ie improvement; feasible, ie offer facility in setting and administering tests.
Other interactive sessions included, 'What can marketing do for health librarians’ and 'From charms to change - how to manage change when all else fails'. I was tempted by the latter!
An interesting parallel session was 'Information outreach services to primary care' - a timely discussion as we in Ayrshire and Arran work towards implementing our strategy. Nia Wyn Roberts, of the Cairns Library in Oxfordshire, spoke of a pilot outreach library service to primary care staff in Oxfordshire. These staff members were in the past served in an ad-hoc manner, the service poorly funded, under-publicised and uncoordinated. Services were centred in Oxford, though most staff were widely scattered. Such a situation is familiar to us in Scotland. The impetus for change came with the national emphasis on primary care, and an outreach librarian was appointed. A tailored training package was developed, in collaboration with the ECDL trainers. Thus the training became relevant, and took place in the staff's own workplace.
The outreach librarian became the face of the library service, and at the same time the main library service was publicised. Requests became routinely delivered electronically or by post, ensuring staff had no need to visit the main library. The outreach Librarian found she had to take on new working methods - and achieve organisational, communication and training skills. She had to be flexible, as training often took place out of normal working hours. Take up was sometimes slow, so the outreach staff had to persevere, offering ten minute training sessions or using 'champions' from the primary care staff to promote the service. The outreach librarian at times felt isolated, and had to make her own contacts, often with other outreach librarians. The project was independently evaluated by ScHARR, and user reaction was positive. Staff appreciated workplace training and access to online resources, which were regarded as supporting CPD and patient care. Some negative responses indicated how the service should be improved, such as library services being available at more suitable times, problems with geographical location and lack of awareness of the library's facilities. The service is now actively responding to such feedback.
Carsten Mandt, of Greater Glasgow Primary Care Division, described a very different solution to outreach. As in several other parts of Scotland, Primary Care in Glasgow was traditionally served by a library - the Maria Henderson at Gartnavel Royal - whose primary responsibility is mental health. While Glasgow does not have a rurality issue, there is a very large, scattered primary care workforce. Carsten was appointed 'to support Clinical Governance and the use of evidence-based care'. His post was initially a project, funded by Clinical Governance, during which he attended team meetings, carried out literature expert searches and trained clinical staff. His post was separate from the day-to-day library service. The clinical governance manager was the gatekeeper through which staff accessed his services which were thus delivery responsive, meeting needs as they arose. The pilot was judged a success, and the post is now fully within the clinical governance structure. The clinical librarian performs literature searches, produces a monthly guidelines newsletter, supports journal clubs and offers training, both group and individual. Staff response is positive, and while initially slow, uptake is growing, though Mental Health Staff still form the largest customer base.
Difficulties remain with primary care, due to geographical spread, lack of funding and reluctance by some medical staff to practice evidence-based health care. These two presentations were revealing and timely comparisons of two solutions to the question of outreach which many of us are now addressing. Both expressed willingness to share their experience with other services who plan to appoint an outreach or clinical librarian. Other parallel sessions included 'Creating e-learning tutorials to teach information skills' and 'Providing information and knowledge services to mental health and emergency care staff.
Impressions
The conference overall was wonderfully stimulating. Each time I attend such a conference, my exclamation is 'This conference was specially valuable in such a time of rapid change'. Our profession, like most, must keep adapting as we face exciting challenges and serious threats. In another two years, today's issues, such as clinical librarians and Agenda for Change, will have been resolved and replaced y new topics. We must face the threats of technological change and the possible devaluing of our skills.
As I listened to the presentations, I occasionally felt it was all a little unreal, too far removed from the real world. Ann Wales on the final morning brought me back to earth. In the discussion on NHS strategy in Scotland and England, Ann reminded us of how far we've come since HDL(01) in 2000. We now in Scotland have co-ordinate services, equity of access, a strategy directly aimed at improving the patient journey, and the elibrary which is the envy of health librarians throughout the UK. We can be proud of what we have achieved in Scotland, and must continue to promote and exploit our excellent resources. Ann outlined 'Exploiting the power of knowledge in NHS Scotland' to the conference, and delegates were clearly impressed by the clarity of the strategy, and to the extent that it has been widely implemented.
This was a fitting end to the proceedings, demonstrating what can be achieved with the drive, co-operation and enthusiasm of all concerned. I must finish by commending the city of Belfast and the conference organisation. The Belfast people were the most welcoming and friendly I've ever met even rivalling Glasgow's! The sun shone, the Waterfront Conference Centre had wonderful facilities and the catering first class. The conference organisers are to be congratulated in ensuring that all ran smoothly, to perfect time, in well equipped meeting rooms. The Health Libraries Group committee prepared a very interesting and varied programme. It is a tribute that the organisation was so seamless as to be barely noticeable - our thanks go to all who made these such a memorable few days. I appreciate the generosity of the Shine Committee in allowing me to attend Belfast. To those considering whether these conferences are worthwhile, I strongly recommend giving it a try. Take the chance to get away for a few days in such a stimulating, supportive environment. I assure you, you'll return with fresh enthusiasm and lots of new friends.
Janice Grant Ayr Hospital Library Dalmellington Road Ayr KA6 6DX Telephone: 01292 610 555 x4119 Email: Janice.grant@aaaht.scot.nhs.uk