Category Archives: #AMillionDecisions

New study identifies positive benefits of the embedded librarian role

A mixed-methods research study, funded by Health Education England, has identified several positive benefits resulting from a librarian working in a critical care team. A return on investment (ROI) analysis indicated that for every £1 invested in the embedded librarian model, a financial value in a range from £1.18 to £3.03 was generated.

Knowledge about conditions and treatments in critical illness can be complex. The critical care team at Wirral University Teaching Hospital NHS Foundation Trust, led by Dr Girendra Sadera, collaborated with the University of Liverpool and the Centre for Health Economics and Medicines Evaluation at Bangor University to design, implement and evaluate a model of knowledge mobilisation, led by a clinical librarian, to support the knowledge requirements of critical care.

A librarian worked alongside staff in the critical care department for 15 months, delivering a “pop up library”, providing evidence support, training both face to face and virtually, and attending meetings, journal club and other departmental activities. The model supported learning and education across all staff groups, nurtured an evidence-based culture and enhanced the quality of care.

The study findings highlight the pivotal role of the critical care nurse in sharing knowledge between staff and patients; the bedside nurse was considered approachable, reassuring, knowledgeable and trustworthy, and they were a preferred source of knowledge for the patient and family.

Findings demonstrate that a librarian working in a clinical team can feasibly support the knowledge requirements of staff. Return on investment analysis indicated that for every £1 invested in the knowledge mobilisation model, a financial value of £1.18 to £3.03 was generated in time saving, enhanced professional development and improved patient care.

For further information about the study please contact Dr Girendra Sadera, Consultant in Critical Care, girendra.sadera@nhs.net.

Impact Reminder and Update

A number of colleagues have asked for a reminder about the processes for submitting impact case studies, and around vignettes and social cards.  Therefore, this blog serves as both a reminder and an introduction for colleagues new to the process.

Impact Toolkit

The Knowledge for Healthcare Blog includes a Value and Impact Toolkit which includes links to the national Generic Impact Survey.  We recommend that services use these core questions in their own local surveys and from time to time we will ask colleagues to share your data with HEE LKS Leads so that we can collate it nationally.

You will also find an interview template on the blog which may be useful in gathering qualitative impact data from library and knowledge service users.  An Impact Case Study template provides a resource for collating the key details from the interview. 

Services are then encouraged to submit completed case studies through the blog.  These are reviewed by teams of LKS colleagues from across the country and, where they meet the key criteria, added to the blog.

While you are not obliged to use the Impact Case Study template, you may find it easier to do so.  It has been designed in such a way as to encourage you to meet the criteria used for review later. Therefore if you use an alternative format we would encourage you to look at the criteria to make sure you are capturing the key elements in your narrative.

What happens after submission?

Once you have submitted your case study these are periodically sent to LKS colleagues for review against the criteria.  If they meet the three core criteria of clarity around what has been achieved, the impact involved, and the role of the library, then they are added to the Case Studies listing on the blog.

We encourage services to include quotes from named library champions in case studies.  If this is present, and if there is detail of cost or time savings, or similar high-level impact, then these case studies are developed into impact vignettes.  The impact vignettes are shared on the blog and also fed back to the service which submitted the corresponding case study and the local HEE LKS Leads.

What if I want to create my own vignette?

Templates for the development of vignettes and social cards have been made available on the blog.  These are intended for local use by your service in developing promotional tools.  You do not need to send any locally created vignettes to us via the blog because, where appropriate, we will develop these from your reviewed case studies.

What is the difference between a vignette and a social card?

The vignettes feature headlines, summaries and quotes about impact case studies whereas the social cards feature senior leaders endorsing #AMillionDecisions, providing a photograph and quote about the role of librarians and knowledge specialists in enabling the use of evidence and knowledge to inform decisions. ​

Supporting health care systems to reduce variation and nurture a learning culture

As health care organisations transition to health care systems delivering services across a geographical footprint, there is a wealth of opportunities for library and knowledge services to support and enhance evidence-based care.

A 2017 study, despite being published a while back, demonstrates the enormity of the challenge facing the NHS of ensuring that all patients receive high quality, evidence based care. It’s a useful study for us as library and knowledge professionals to be aware of, highlighting as it does the level of variation and reasons why our expertise in mobilising knowledge is such an important contribution to the delivery of high quality health care.

Willis et al (2017) explored the variations in achievement of evidence-based, high-impact quality indicators in general practice. Seven high impact quality indicators were developed for primary care and the variation in achieving these indicators was measured across GP practices in West Yorkshire. Four indicators focused on processes of care (e.g. prescribing or testing) and three on clinical outcomes (blood pressure, cholesterol and glycaemic control).

Two key findings in the study are of particular interest.

1) The performance of GP practices in achieving quality indicators.

Achievement of the seven evidence based quality indicators across participating GP practices was as follows:

  1. Diabetes processes of care: 59.1%
  2. Risky prescribing: 8.7% (a low percentage indicates safer, more desirable practice)
  3. Anticoagulation in atrial fibrillation and risk of stroke: 63.0%
  4. Secondary prevention of myocardial infarction: 54.6%
  5. Diabetes control: 43.2%
  6. Blood pressure control in hypertension: 71.7%
  7. Blood pressure control in chronic kidney disease: 74.2%

These differences against quality indicators are perhaps expected, and demonstrate that some GP practices are struggling to achieve evidence-based practice in key areas of patient care.

2) A marked variation in performance between practices

The second key finding of interest to us is that the likelihood of receiving evidence-based treatment varied substantially as a consequence of the practice attended. Even accounting for contributing factors (such as the age profile of patients), the study found considerable variation in achievement of the seven quality indicators between GP practices.

What can we draw from this? It highlights that there are likely to be several contributing factors at play that prevent evidence-based recommendations from being implemented. According to the authors, this is likely to be due to differences in culture and behaviours:

“The odds of patients receiving recommended care or achieving recommended treatment targets varied between two- and over ten-fold by indicator according to the practice attended. These marked variations were partly explained by a range of routinely available practice and patient variables; it is likely that much variation is related to clinical and organisational behaviours.” (p11)

Library and Knowledge Services can play an active part in enhancing clinical and organisational information behaviours in health care systems. This may be through ensuring easy and timely access to the evidence base, equipping health care staff with skills in information searching and critical thinking, or embedding optimal knowledge management behaviours to encourage a learning culture. Accordingly, our contribution to organisational culture and behaviours can support health care systems to reduce unwarranted variation and improve the quality of care.

As knowledge specialists working in health, we are keenly aware that there is a gap between evidence and everyday practice, but perhaps most people attending an appointment at their local practice isn’t?

Reflecting on the findings of this study presents some interesting challenges to us as a profession. Firstly, as our perspective shifts towards supporting the knowledge requirements of health care systems, how can we work more effectively together to help the NHS tackle unwarranted variation in treatment? Secondly, knowledge management is more than simply disseminating evidence across our networks. How can we use our skills to influence behaviour, and how far should our role extend into embedding evidence into practice? Finally, library and Knowledge Services have a role in ensuring citizens are supported to self-manage their conditions effectively and are empowered them with knowledge. How can we do that most effectively?

Please share your thoughts on the issues discussed here, and if you have any interesting studies on this topic please share them too!

Victoria Treadway, Knowledge Management Facilitator, NHS RightCare Email: victoria.treadway@nhs.net Twitter: @librarianpocket

References

Willis, Thomas A, West, Robert, Rushforth, Bruno et al. (5 more authors) (2017) Variations in achievement of evidence-based, high-impact quality indicators in general practice : An observational study. PLoS ONE. e0177949. ISSN 1932-6203 https://doi.org/10.1371/journal.pone.0177949