In the NHS LKS community we have been pondering for years, if not decades, how we might streamline inter-lending and document supply processes, in order to:
make it quicker and easier for LKS staff to manage requests and source suppliers
make it quicker and easier and for end users to place and receive their requests
optimise use of NHS- purchased content and reduce the risk of paying external sources for articles which are in fact available within the NHS
In recent years, reciprocal inter-lending and document supply has extended to cover the whole of England. The INC scheme is a great example of working collaboratively across the country. However, the underpinning systems haven’t necessarily kept up. ILL staff have developed smart ways of working, but it can still be unnecessarily time-consuming to check different catalogues, copy and paste data from one system to another, or maintain holdings data and library user information in more than one place. The need to ensure compliance with copyright and data protection legislation adds to the complexity. The mechanics of requesting items are also different for end users across the country.
The arrival of the National Discovery Service and the plan to migrate towards fewer, regional library management systems presents an opportunity to review document requesting and supply workflows and consider what improvements may be made. Library services which have implemented local discovery systems report that this can increase demand for inter-lending and document supply services. We need sourcing and supply processes to be as efficient as possible to meet the demand and extend the reach of our services.
So, as the National Discovery Service and library management system work progresses, we will work with system suppliers and library staff to explore opportunities. Please look out for future requests for input from library staff willing to help us with considering workflows and test solutions. More news to follow in due course.
For more information on the National Discovery Service, have a look at the FAQs.
Jenny Toller, chair of the SINC Group which oversees the INC scheme
Surrey and Sussex Healthcare NHS Trust
(SASH) is one of the five NHS organisations
that have been working in partnership with the Virginia Mason Institute
(VMI) to develop a culture of continuous improvement in the NHS based on lean
Surrey and Sussex Healthcare this work is known as “SASH+”.
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
The need to make some changes to our ILL
(inter library loan) process was identified during a “Waste Walk”.
A Waste Walk involves team members walking around the “Gemba”
(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. 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”
. 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).
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.
Using a process called “standard
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”
was developed. Using this we were able to identify opportunities for improvement
(kaizen bursts), but at this stage not the solutions.
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”.
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
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.
I have been trying to turn statistical data from the national collection into information that tells me something about trends and/or the health of our libraries in the south. My thoughts from this exercise may help the Metrics Task and Finish group as one of our next tasks is to review the statistics collection.
First of all I had to decide which of the 139 lines of figures submitted would work well in comparison across the years. I couldn’t compare everything as there probably aren’t enough hours in the day to go through the whole lot, besides which I think a certain boredom factor might intrude on the thinking processes. I worked with Tricia Ellis to decide which lines to include. We wanted some analysis that would identify trends and patterns of progress, investment and activity. We tried to work out which statistics would show our successes and went for 1. Income and expenditure 2. Staffing levels 3. Library activities, i.e. loans from stock, user education sessions, literature searches undertaken, etc. and 4. Changes to library infrastructure, e.g. WI-FI access
These are the specific areas I looked at comparing three years of submissions for the South West: 2012-13, 2013-14 and 2014-15
What did I learn?
Income and Expenditure – Library income has not changed very much over this period, some libraries have lost income where staff have moved to other Trusts but this meant that another library in the area then gained that income. However, the non-recurring income has fluctuated wildly, only one library has non-recurring funds which remained fairly static. For some libraries this may be significant as they rely on these for their service. I felt that these funding figures didn’t really tell me a lot so I had the idea of looking at the number of users and maybe working out what each library spent per user.
Total number of users – is this an indicator of the busy-ness of the library? Of course this depends on data cleansing – if some libraries do not clear out expired users from their systems they may be over counting memberships. In order to get a more meaningful comparison of libraries I split them into two groups – small and large libraries based on library staffing figures. I compared memberships with expenditure and was able to work out the average spend per user. This made me ask a question – to show value for money should we be increasing our library membership and decreasing our expenditure so that the average spend per user would actually get smaller? Staffing levels (wte and staffing mix) – the data includes library qualifications, other qualifications, none. I did not pick up on any trends in staffing levels, most remaining static, there are some discrepancies due to reported vacancies. In the South West over 50% of staff have a professional qualification and are paid on Band 5 or over. 12% of staff have a paraprofessional qualification. I found out that we have had and have maintained a well-qualified set of staff.
Loans from stock – includes renewals, but there are variants as each library has a different number of loans and renewals allowed. In some libraries book loans to own readers have gone down but overall figures look fairly static showing that our book stock is still of importance to library users. Loans to local networks have gone down slightly as would be expected with the increase in ebooks. This figure could be an indicator of the importance of the collection to others and shared resources remain vital to the cost effectiveness of libraries and ease of access to our readers.
Copies supplied by other libraries – local networks, British Library, or others – I was looking for trends. Most libraries show a downward trend for document supply but there are exceptions with two or three libraries trending upward. No conclusions to be drawn here.
Literature searches – total number of mediated searches – are these increasing or decreasing? In the South West there has been a steady increase which is encouraging as this is one of the areas where some analysis of searches can show how the service impacts on management and clinical decision making.
User education and induction – numbers being made aware of our services. There appears to be a lack of consistency in the way librarians collect these and figures vary greatly – for example, one library has done nearly 5000 inductions in one year whereas all the other libraries have figures nearer to the figure of 700. Two libraries simply can’t supply these figures but don’t say why. Without comparing membership figures it is hard to tell whether the smaller libraries are doing just as well as the larger ones in providing user education.
Current awareness – bulletins, blogs, RSS feeds and social media – the number of blogs increased, RSS feeds figures are static, Social Networking has increased but some Trusts don’t allow libraries to do this so it feels unfair to compare them. As we are simply counting yes or no in this area I can see the activity but this figure does not tell me about outreach or impact. Do library managers analyse the activity in this area to get a more meaningful result?
Journals – print titles, electronic only, print with electronic. Electronic only titles have increased. Nothing really useful to be learned here so why record it?
Collaborative purchase scheme – figures went up and then back down. Although this collaborative purchases is key to getting good value for money the way we record it doesn’t tell us enough, how many resources were made available to how many libraries through these different schemes?
eBooks and Databases – these figures don’t have story to tell – why count?
WiFi – most libraries have WiFi now can we now assume that this is the norm and stop counting it?
I would be interested to know if anyone else has tried to get a “story” from the annual statistics collection and if not, are there other statistics that you have used to plan services or make a decision?