Category Archives: Service Transformation

Running Virtual NHS Library and Knowledge Services

Through our regional networks we are aware that, in line with government guidance, some NHS library and knowledge services staff are working from home, providing virtual services to support access to evidence which is particularly critical at this time.

Local NHS library and knowledge services staff have shared their tips and work-arounds, including working with Information Technology. They share how the services operate and how the staff teams are supported.

We have also compiled resources on working from home. This includes support for staff well-being that may be valuable to share with NHS colleagues.

Do join the conversation in the comments box below, sharing your experience of what works well and resources we can add.

Bradford District Care NHS Foundation Trust (BDCFT)

How we are providing a virtual service: The BDCFT team can offer the vast majority of our resources and library services remotely and most of the team have a work laptop and should be able to carry on with their duties as normal. BDCFT staff can still access the library with a swipe card and issue/return books on a self-service basis. I will suspend all overdue notifications. We have tubs of antiseptic wipes in the library for folk to wipe down the desks and keyboards etc before use. A member of the library team is hoping to pop-in periodically to check that all is ok/top-up the printer paper/update Heritage with returns etc. We will continue to promote all aspects of the service as widely as possible to let BDCFT staff know that we still here to support them and their information needs.

How we support the library and knowledge services staff working remotely: Most of the team do have a work laptop and I am liaising with IT to try and get laptops for the remaining staff, who are currently using their own devices. We are speaking regularly by phone and in touch by e-mail. I am working with IT to get a MS Teams page set up for us and we currently using the Chat function. When this has been set-up, I am planning a morning huddle each day to catch up with everyone. All members of the team have sent me through a list of what tasks they can work on from home so I can ensure that all possible services are being covered.

Contact for more details: Becky Williams
Mobile: 07747769999
Email: rebecca.williams@bdct.nhs.uk

Royal Papworth Hospital

[Note: Papworth has been a virtual service since a site relocation in April 2019]

How we are providing a virtual service: The methods of providing a virtual service are very straightforward. Our laptops have the Library Management Software installed and we access Trust shared drives via VPN.  All user requests are submitted digitally via our website: literature search, training, articles, registrations.

The forms are available on our website. (So please have a look if you think these will be helpful to you.) When the user completes the form, it is delivered to a shared mailbox. Different staff members pick up different tasks. We colour code them so we each know what’s unassigned, in progress or completed. When trouble shooting user problems, we usually talk people through step-by-step over the phone and provide screenshots by email or by screen-sharing through Cisco Jabber.

In our contingency planning for the move, our Clinical Outreach Librarian, Rebecca Rowe recorded 3 of her training sessions: academic writing, reflective writing and writing for publication. These of course will be helpful now training is suspended.  Again, please utilise these if they are of help to you or your users.

How we support library and knowledge services staff working remotely: Firstly, I will say that I have always tried to see each team member once a week and monthly 1-1s are always face-to-face; having said that, it is easy to develop ways to support the team when you are working remotely. I usually begin the day by emailing everyone a ‘hi, how was your evening?’. It opens a dialogue and the responses give you a feel for if there’s anything non-work related that they need to share. I always say call me if you need anything (my work phone number is connected through my laptop with a headset and mic). I might phone them during the day if we’re trouble-shooting something. Feedback is also important so emailing your thanks or recognition for their work is vital. Team meetings can work well virtually too especially if you have webcams because then you can ‘see’ each other and it feels good.

Contact for more details: Becky Scott
Tel: 01223 639733
Email: becky.scott2@nhs.net

Gloucestershire Hospitals NHS Foundation Trust

How we provide a virtual service: Currently working from home using “virtual laptop” provided by our Trust. Access to generic email for enquiries, also CLIO for document supply and updating website and Twitter. Can access library catalogue but need for this may be inconsequential. Main service is provision of literature searches and enquiries with patient care and business decision making queries are prioritised. Piloting use of Skype to provide support to those who want help with finding evidence, especially if they are self isolating or working from home. If library becomes unstaffed but still open signage will be placed to say to contact generic email, this will also publicised on Twitter and website.

How we support library and knowledge services staff working remotely: Daily morning call to discuss work for the day. Regular contact throughout the day via phone and email – this may decrease when I am redeployed.

Contact for more details: Lisa Riddington
Email: lisa.riddington@nhs.net

Hampshire Healthcare Library Service

How we provide a virtual service: This is all about communication – we use our Trust private Facebook pages, twitter, posters with various contact details and have put messages in the Trust weekly bulletins and ensuring that out-of-office messages are utilised. We are keeping all avenues of communication open – we have a work mobile phone that is being monitored (and in order to reduce pressure on that phone we have also offered a text only mobile phone number). I am keeping my team updated with a daily message and ensuring that all appropriate URLS are sent home via email.

How we support library and knowledge service staff working remotely: We have collated all contact details and asked who has the capability for working from home – as we provide services for two Trust it gets complicated, but Hampshire Hospitals staff have all had remote access enabled. Southern Health Foundation Trust staff – three of us have laptops already, but remote access is not enabled for other staff other than using NHS.net emails or personal emails (with permission). We have ensured that all email inboxes are delegated to at least two other people. We have also signed up to Slack to provide some real-time conversations and social connections without using teleconferences as their library service manager (me!) is deaf which makes life complicated.

Contact for more details: Sam Burgess
Email: sam.burgess@southernhealth.nhs.uk
Twitter: @samanthaclare

Bodleian Health Care Libraries

How you provide a virtual service: We’ve had to un-staff our libraries and switch to a virtual service in 2/3 days.

  • We’re signposting the available online resources at our libguide (OpenAthens etc.).
  • We’re working with our Director of Medical Education to collate an online list of resources and looking at getting electronic copies of books we’re missing.
  • All books currently on loan have been auto-renewed until 19 June 2020 andny fines will be waived.
  • We’re offering our Searching, Training, Help and Advice services online.
  • We have a rota for enquiry cover including dialling in to check answerphones and enquiry email monitoring. We offer training and consultations via telephone, Skype and other online platforms so will continue to do this.

How you support the LKS team working remotely: We’ve become experts in MS Teams in 2 or 3 days! We’re using it to communicate with each other and store documents. We have a number of channels set up within it including a “staffroom” where work chat is banned – it’s purely for the kind of stuff you discuss over a cup of tea or coffee. So far it’s got pictures of bird feeders, goldfish and biscuits! We’re going to use it to set CPD tasks for staff who may not have work they can complete from home but will still make them feel involved. We also have a member of staff phoning people for a chat and we’re formalising how we’ll keep this going. – a lot of what we’re doing is working out how to keep up communication and pastoral care. Many of our staff live alone so we want to make sure they’re OK personally as well as professionally.

Contact for more details: Owen Coxall
Email: owen.coxall@bodleian.ox.ac.uk

Looking for inspiration for Health Information Week 2020 (#HIW2020)?

Health Information Week is a national, multi-sector campaign to promote high quality information for patients and the public. High quality health information can have a huge impact on people’s ability to stay healthy and manage illnesses effectively, giving them a better quality of life. This year, #HIW2020 runs from Monday 6th to Sunday 12th July.

Are you interested in being involved in #HIW2020 but not sure where to start? Or maybe you’ve been involved for a number of years and you’re looking for something different to do this year? Perhaps you don’t feel you have the resources to do much? Alternatively maybe you’d like to do make #HIW2020 a really significant part of your outreach work this year? The good news is that you can spend as much or as little time as you have on #HIW2020, from running a week long programme of events to simply retweeting posts from @HealthInfoWeek.

The Ideas Bank is a great place to start. It includes all the ideas from previous years, and we’ve recently updated it to include new ideas from #HIW2019 activities run by different teams from across the country. Maybe a walkabout to key teams would be more effective than a display? Maybe you can ask a health professional to present at a public library or other public venue?

The Ideas Bank includes:

  • Tips for making contact with teams in your local area who may be interested in working with you, both inside and outside your organisation
  • Ideas for teams with limited time and resources
  • Fun ideas to draw a crowd
  • And more!

And if you have other ideas, please let us know – other people may find them really useful too. Email us on Healthinfoweek@gmail.com or Tweet us on @HealthInfoWeek

Your organisation’s Covid-19 response may affect the planning you can do at this stage. Dependent on how things develop, it may also affect what is possible during #HIW2020 itself. Follow national guidance, and also your local guidance. Some of the things in the Ideas Bank would not be appropriate during current precautions – they are included in hope that by Monday 6th July, they will once again be safe. Other things, such as social media use, can continue as usual during Covid-19.

Lindsay Snell on behalf of the HIW team

Streamlining – System Change an Inch Wide and a Mile Deep

Surrey and Sussex Healthcare NHS Trust (SASH) is one of the five NHS organisations[1] that have been working in partnership with the Virginia Mason Institute[2] (VMI) to develop a culture of continuous improvement in the NHS based on lean principles.   At Surrey and Sussex Healthcare this work is known as “SASH+”[3].

The small system change, or in Lean parlance “value stream”, relating to the processing of document supply requests from users which is described here was implemented using some of these lean processes.

The need to make some changes to our ILL (inter library loan) process was identified during a “Waste Walk[4]. A Waste Walk involves team members walking around the “Gemba”[5] (the place where work happens i.e. the library) identifying the seven different types of waste (time, processing, defects, motion, transportation, inventory and overproduction).  Waste can be a contentious word to use, here it means any activity, product etc that does not add value for the patient or customer[6].  On this occasion I was carrying out the waste walk with our two senior library assistants.  One of them identified that the way we currently processed ILL requests when a user sends in multiple requests via email (ie not on ILL request forms) was a type of processing waste, this was a particular issue when a user requested a lot of items from one literature search, in such cases the user replies back to the librarian saying “I would like the following items please”.  Yes, we do encourage users to click on the links and yes, when we send the search results we do send them a link to our online request form, but once they have replied requesting a number of items, the library assistants question whether it is helpful to go back to the user and to ask them to complete this process.  In lean terms this would not be the option to choose.

However the current process was time consuming for the library assistants and involved them filling out the user’s contact details on a request form, copying it multiple times and then cutting and pasting the individual article details onto the request forms; a time consuming and fiddly process which actually was taking up their time when they could have been doing more valuable work for our customers. This therefore became our Value Stream.

The next stage was to identify what was currently happening, how long it was currently taking to complete, and how much of that was waste.  One of the Lean methodology’s mantras is when dealing with a problem you break it down so that you address only a small part at a time that is “an inch wide but a mile deep[7] .  The boundaries for this value stream were from: when the librarian sends the user the search results, to: the library assistant getting the individual requests onto the ILL request forms ready for processing.  We then narrowed the focus down to just looking at getting the multiple requests onto individual request forms.

By observing the library assistants carrying out this work I was able to create a diagram to show the flow of the work (flows of medicine[8]).  Having drawn the flow of work we (library assistants and I) were able to step back from the process and see clearly that there was a lot of going to and from the photocopier/printer, which was not only wasteful but meant the library assistants were often interrupted during the process of completing the request forms.

Flows of Medicine

Using a process called “standard operations”[9], which included timing the process seven times, I was able to establish the that the whole process took on average took 25 minutes per request item of which 53% was non value added (i.e. waste), and the specific part that we wanted to improve (writing out the request form) took 13.9 minutes and 12.3 minutes (88.5%) were not value added.  Not necessarily an easy thing to discuss with your team members, but because of the flows of medicine diagram and the timings they agreed that this was where we needed to focus our attentions.

To get a clear picture of the activity and the sub-stages, value and non-value added activity a “value stream map”[10] was developed. Using this we were able to identify opportunities for improvement (kaizen bursts), but at this stage not the solutions.

Value Stream Map

Having established what the issues were, we could then start to address them.  We wanted to reduce the “internal set-up” time when processing multiple ILL requests from one user i.e. the time it took to get each article request onto a request form. We needed to find a way to reduce the internal set up by either getting rid of steps in the process altogether or by moving some activities to “external set-up” i.e. creating a standard work process that takes place in advance, having a standard ILL request form was standard work, but in this case when there were multiple requests from one user it was not effective, a process known as “set-up reduction”[11]. We did address other issues but our main external set-up solution was a multi sheet spreadsheet. The spreadsheet had multiple sheets with the same form on each sheet.  When the user’s details were entered on the first sheet they were automatically copied across to the other sheets and the library assistant then just needed to copy and paste the individual article details from the literature search results document into the spreadsheet, send it to print and go to the printer/copier to collect the completed forms.

By introducing an electronic form on a spreadsheet we were able to reduce the time taken for the whole process to 14 minutes i.e. reducing the time taken by 44%, and crucially the specific element of getting the requests onto the ILL forms down to 5 seconds. That is a 99.4% time reduction.  My thanks in particular go to Adam Blackwell Senior Library Assistant who allowed me to observe and time him at work and worked with me on finding and testing out solutions.

Rachel Cooke
Head of Library Services & Knowledge Management
Surrey and Sussex Healthcare NHS Trust


[1] https://improvement.nhs.uk/resources/virginia-mason-institute/ accessed 17/02/20

[2] https://www.virginiamasoninstitute.org/ accessed 17/02/20

[3] https://www.surreyandsussex.nhs.uk/about-us/about-the-trust/sash/ accessed 17/02/20

[4] https://www.virginiamasoninstitute.org/2016/06/identifying-the-seven-wastes-to-build-a-lean-foundation/ accessed 18/02/20

[5] Graban, M (2016) Lean hospitals: Improving quality, patient safety and employee engagement 3rd edn. Boca Raton, CRC Press, p316

[6] P 319 Graban, M

[7] https://www.hfma.org.uk/docs/default-source/healthcare-finance-pdfs/June-2016/20-24_jun16_virginiamason-final.pdf?sfvrsn=0 accessed 17/02/2020

[8] Plsek, P (2014)  Accelerating Healthcare Transformation with Lean and Innovation: The Virginia Mason Experience. Boca Raton, CRC Press, p189

[9] Plesk, P p189

[10] Graban, M pp75-78

[11] Stark, C and Hookway, G (2019) Applying Lean in Health and Social Care Services: Improving Quality and the Patient Experience at NHS Highland. Milton Keynes, Routledge Productivity Press.  pp117-119