International perspectives and initiatives DOI: 10.1111/hir.12050 Abstract This is the 9th in a series of articles exploring international trends in health science librarianship. The previous article in this series looked at Northern Ireland and the Republic of Ireland. In this issue the focus is Scotland and Wales. There will be three or four more articles this year tracking trends in the Far East, Africa, South Asia and the Middle East. JM Keywords: case studies; Great Britain (GB); librarianship, health science; library and information professionals; National Health Service (NHS); national strategies International trends in health science librarianship Part 9: the UK Scotland and Wales Ann Wales Programme Director for Knowledge Management NHS Education for Scotland, Knowledge Services, Glasgow Translating knowledge into action to improve quality of care: routemap for knowledge management in Scotland s health and social services Librarians and knowledge services are developing as change agents to help catalyse transformation of Scotland s health and social services, as outlined in Scotland s Quality Strategy 1 and 2020 Vision. 2 Translating knowledge into quality of care The primary driving force for change is the unique potential of knowledge services to help bridge the chasm between knowledge and frontline practice. 3 Fourty five percent of patients do not receive care as recommended in published evidence and guidelines, 4,5 and it can take 17 years or more to translate research into frontline practice. 6 We need to go beyond our traditional role in providing access to knowledge and support practitioners to apply knowledge in practice. The national Knowledge into Action strategic reviews in National Health Service (NHS) Scotland 7 and Social Services, 8 recommend a model of knowledge as process rather than product, embedded in practitioner workflow to translate knowledge into frontline care. This model recognises the limitations of research knowledge. 9 11 To deliver care in a personalised, context-sensitive way, research knowledge needs to be combined with knowledge from practice of local systems, contexts and processes and from experience of staff and service users. The Knowledge into Action implementation programme aims to develop librarian capabilities 12 as the core of a national knowledge broker network, collectively providing four services which the evidence base 13 indicates can help staff apply knowledge in practice and service improvement: Sourcing and combining knowledge from research and experience know-what and know-how. Packaging this knowledge in formats easy to use in day-to-day practice for example decision aids, decision support, care pathways, mobile apps. Sharing and spreading knowledge through people networks for example communities of practice and social networking. Training health and social care staff to find, share and use knowledge for themselves. This refocusing of knowledge services integrates them firmly with delivery of Scotland s Quality Strategy. Supporting public services integration The strategic narrative to enable delivery on Scotland s Quality Strategy is the 2020 Vision of 79
80 International perspectives and initiatives integrated health and social care, 2 delivered in the community, close to home, and centred on the needs of the individual. This is part of a wider agenda around public services integration. 14 Implementation of the health and social services knowledge strategies is progressing as an integrated programme of work under the auspices of a national Health and Social Services Knowledge Advisory Board. This gives a strong steer to develop the knowledge broker network as a multiagency collaboration, involving librarians and colleagues from other professional backgrounds in education and training, research, information support. This network will also help to make connections across knowledge support for practitioners, service users and carers, to support shared decision-making and person-centred care. Focus on impact The focus on application of knowledge brings with it a responsibility to demonstrate the contribution of knowledge services to improving practice and outcomes. Knowledge into Action has defined an evaluation framework to measure impact of knowledge support, 15 at project and programme levels, on practitioner engagement, knowledge, practice and ultimately health care outcomes. Examples of the knowledge broker network providing knowledge into action support for health care priorities include: National Sepsis Collaborative sourcing and summarising evidence and examples of implementation; providing a mobile app to detect early warning signs; sharing experience in a community of practice. Diabetes supporting a multi-disciplinary community of practice to implement evidencebased decision support prompts in the electronic health record system; collaborating across agencies to provide knowledge support for people with multiple conditions. Preventing adverse events creating 5-minute Clinical Consults summarising evidence and prompts to prevent failed or missed diagnosis for common non-specific symptoms in older people attending general practice. Early Years identifying knowledge broker roles and knowledge into action processes in education, local authority and voluntary sector early years settings. Technology-enabled learning Knowledge into Action has positioned itself as an integral part of Scotland s ehealth, 16 Telehealthcare 17 and digital strategies, 18 and the strategic lead is working with partners to develop a national technologyenabled learning action plan. This will support health and social services staff to develop their skills in using technology as an integral part of delivering care. It also aims to address fragmentation in the online learning landscape by providing a common, multi-channel platform for online learning for health and social services staff. This will exploit new approaches to knowledge support, including integration with clinical and care systems, social networking, Internet broadcasting and open access publishing. Summary In summary, knowledge support in Scotland is responding in a strategic, proactive way to the policy challenges of quality improvement, public services integration and digital innovation. We are managing a planned transition to make knowledge services an integral component of health care quality and service transformation a dynamic, networked health and care service that exploits technology and provides evidence-based support to translate knowledge into frontline delivery of care. References 1 Scottish Government. The Health care Quality Strategy for NHSScotland [online]. 2010 [last accessed 2013 August 11]; Accessible at: www.scotland.gov.uk/resource/doc/ 311667/0098354.pdf 2 Scottish Government. Achieving Quality in Scotland s Health care. A 20:20 Vision [online], 2012. [last accessed 2013 August 11]; Accessible at: www.scotland.gov.uk/topics/health/policy/2020-vision/strategic-narrative 3 Institute of Medicine. Crossing the quality chasm: a new health system for the 21st century. Washington DC: Institute of Medicine, 2001. 4 Grol, R. Successes and failures in the implementation of evidence-based guidelines for clinical practice. Medical Care 2001, 39(8 Suppl 2), II46 II54.
International perspectives and initiatives 81 5 McGlynn, E. A., Asch, S. M., Adams, J., Keesey, J., Hicks, J. & DeCristofaro, A. et al. The quality of health care delivered to adults in the United States. New England Journal of Medicine 2003, 348, 2635 2645. 6 Balas, E. & Boren, S. Managing clinical knowledge for health care improvement. In: Bemmel, J., McCray, A. T. (eds). Section 1: health and clinical management. Yearbook of Medical Informatics: Patient Centered Systems. Stuttgart, Germany: Schattauer Verlagsgesellschaft, 2000: 65 70. 7 NHS Education for Scotland and Health care Improvement Scotland. Getting Knowledge into Action to Improve Health care Quality: Report of Strategic Review and Recommendations [online] 2012. [last accessed 2013 August 11]; Accessible at: www.knowledge.scot.nhs.uk/ media/clt/resourceuploads/4016980/20120805%20k2a% 20short%20report%20for%20Board%20distribution%20v2% 200.pdf 8 Scottish Government. Knowledge into Practice: A Strategy and Action Plan for Embedding Knowledge into Practice in Scotland s Social Services, 2012 2015, [online] 2012. [last accessed 2013 August 11]; Accessible at: www.scotland. gov.uk/publications/2012/10/4809/downloads#res-1 9 Naik, G. Scientists Elusive Goal: Reproducing Study Results. Wall Street Journal [online] December 2, 2011. [last accessed 2013 August 11]; Accessible at: http://online.wsj. com/article/sb10001424052970203764804577059841672 541590.html 10 Kent, D. M. & Hayward, R. A. Limitations of applying summary results of clinical trials to individual patients: the need for risk stratification. Journal of the American Medical Association, 2007, 298, 1209 1212. 11 Ioannidis, J. A. & Panagiotou, O. A. Comparison of effect sizes associated with biomarkers reported in highly cited individual articles and in subsequent meta-analyses. Journal of the American Medical Association, 2011, 305, 2200 2210. 12 NHS Education for Scotland. A Capability Framework for NHSScotland s Knowledge Broker Network (draft). Edinburgh: NHS Education for Scotland. [online] 2012 [last accessed 2013 August 11]; Accessible at: http://www.widgetlibrary.knowledge.scot.nhs.uk/media/widgetfiles/1003508/ 20121008%20Capability%20Framework%20for%20the% 20Knowledge%20Broker%20Network%20.pdf 13 Davies, H., Powell, A., Ward, V. & Smith, S. Supporting NHSScotland in Developing a New Knowledge into Action Model [online]. 2011 [last accessed 2013 August 11]; Accessible at: http://www.knowledge.scot.nhs.uk/media/ CLT/ResourceUploads/4002569/K2A_E vidence.pdf 14 Commission on the Future Delivery of Public Services. Report on the Future Delivery of Public Services by the Commission Chaired by Dr Campbell Christie [online]. 2011 [last accessed 2013 August 11]; Accessible at: http:// www.scotland.gov.uk/publications/2011/06/27154527/0 15 Centre for Research on Families and Relationships, University of Edinburgh and SMCI Associates. Chapter 7: Evaluation of knowledge into action a framework and tools. In: Knowledge into Action for NHSScotland: methods, strategic national projects and an evaluation framework. A report for NHS Education for Scotland and Health care Improvement Scotland. Scotland: University of Edinburgh, 2013: pp. 77 89. 16 Scottish Government. ehealth Strategy 2011 2017 [online]. 2011 [last accessed 2013 August 11]; Accessible at: http://www.scotland.gov.uk/publications/2011/09/ 09103110/0 17 Scottish Government. A National Telehealth and Telecare Delivery Plan for Scotland to 2015: Driving Improvement, Integration and Innovation. Edinburgh: Scottish Government, 2012. Accessible at: http://www.scotland.gov.uk/ Resource/0041/00411586.pdf 18 Scottish Government. Scotland s Digital Future: A Strategy for Scotland [online]. 2011 [last accessed 2013 August 11]; Accessible at: http://www.scotland.gov.uk/topics/artsculturesport/arts/archive/digitalambition/digitalambitionscotland Developments in Wales Sarah Bruch Library & Knowledge Services Manager Hywel Dda Local Health Board, Llanelli, Carmarthenshire Wendy Foster Library & Knowledge Services Manager Hywel Dda Local Health Board, Glangwili, Carmarthen Meg Gorman Senior Health Librarian Cardiff University & Dean s Library Adviser, Wales Deanery Janet Peters Director of University Libraries and University Librarian Cardiff University Most health librarians in Wales work in the hospital setting and are employed by NHS Wales. A smaller number work in the higher education sector and specialist libraries. Within this provision, Cardiff University has a unique role as the library provider for two local NHS organisations and, due to the positioning of the Wales Deanery within the University, in supporting all post-graduate medical and dental trainees throughout Wales.
82 International perspectives and initiatives Trends Partnership and collaboration Partnership has always played a key role in the provision of service delivery and professional development. All hospital-based NHS Wales libraries and Cardiff University health libraries are members of an operational partnership, the All Wales Health Information and Library Extension Service (AWHILES), providing health information to support patient care, education, training and research for NHS Wales staff, and Cardiff University staff and students on placement. AWHILES seeks to: Develop quality services in response to user needs across NHS Wales Provide a single catalogue for health material using a shared library management system Make best use of resources by operating an efficient interlibrary loan and document supply scheme using electronic methods of document delivery Provide development activities for all library staff. The partnership celebrated 40 years in 2012 and published a book to record the history of AWH- ILES libraries and key events. 1 The effects of the major re-organisation of the NHS in Wales in 2009, resulting in a smaller number of larger Health Boards and Trusts, were softened by the long established culture of co-operation which helped library staff work together in newly formed multi-site library services. AWHILES members meet regularly for business meetings which alternate between face-toface meetings and videoconferencing, making the best use of time given the large geographical area covered. A conference is held annually as well as training days for library support staff. Recently, AWHILES members have collaborated in producing joint policies and procedures, for example a customer care policy in 2013; support for the AWHILES website; and a baseline self-assessment exercise in all libraries using the NHS Library Quality Assurance Framework (LQAF) England in 2011 with a second cycle planned for 2014. Stakeholders hold the AWHILES Partnership in high esteem being recognised by the General Medical Council in their Quality Assurance for Basic Medical Education report for Cardiff University as a model of good practice, which enabled students to have access to resources held by any hospital in the Principality. 2 Cardiff University also acknowledged AWHILES outstanding contribution to the values of the University with the presentation of an award in their inaugural Celebrating Excellence Awards 2012. For the wider group of health librarians in Wales, the CILIP Health Libraries Group Wales (2006) and the CyMAL cross-sector regional groups have been established which provide additional networking and training opportunities. The Book Prescription Wales service is the result of collaboration between health and public libraries, health professionals and the Welsh Government. Partnerships look to develop further with the adoption of the next generation cloud-based library management systems for example the Wales Higher Education Libraries Forum (WHELF) project which will include AWHILES libraries. A recent collaboration between university and NHS Health Boards is to provide an eduroam service across hospital wi-fi to enable staff and students with university affiliations to access university resources. Currently available in two Health Boards, it is hoped to roll this service out to all hospitals in Wales. Changing roles National and local developments have contributed to a recognition of the skills of the librarian. Nationally, librarians selected resources for the NHS Wales e-library in 2005 which was followed in 2009 by an invitation to sit on both the steering group and the stakeholder group for the e-library. Those involved have played a key role in reprocurement exercises. Local re-organisations have required some librarians to diversify and take on further roles beyond their own site library. The complexity of e-resource licences and copyright issues requires an increasing level of legal knowledge, for example, interlibrary document supply is affected by not only the Copyright Act but also
International perspectives and initiatives 83 the differing CLA licences in each UK home country and sector. Information skills teaching has assumed greater importance in all health libraries along with critical appraisal and systematic reviewing skills. The use of Web 2.0 software along with the developments in mobile devices is encouraging an inventive approach to engaging with users in teaching, marketing and enquiry services. The role of the clinical librarian continues to be explored. Improved library facilities Over the past 10 years, there has been investment in new and improved library facilities across NHS Wales, an indication of their value in supporting patient care, education and research. Within the higher education sector, the Health Library at Cardiff University was opened in 2011 in the new Cochrane Building on the University Hospital of Wales site. It is the largest health library in Wales. Conclusion Welsh health librarianship has developed considerably since 2000 due to a culture of collaboration and advances in technology. There is the constant battle to retain funding and maintain the profile of the health library in organisations, which are facing almost continual change. However, librarians continue to thrive in this environment and plans for the future include developing the use of mobile technology, Web 2.0, joint procurement and sharing of resources, harvesting data on library activities to inform service delivery, continued professional development and progressing with accreditation to ensure the quality of services for future generations of NHS Wales staff. It is notable that once in post in Wales, very few health librarians leave! References 1 Bailey, R. et al. eds. AWHILES at 40: a history 1972 2012: Personal Reflections Written by AWHILES Librarians/All Wales Health Information & Library Extension Services. Wrexham: Print Centre Wales, 2012. 2 General Medical Council. 2006. QABME: The School of Medicine, University of Wales Report for 2005/06. [Online]. London: General Medical Council. Accessible at: http:// www.gmc-uk.org/static/documents/content/cardiff_2006.pdf [Accessed: 31 July 2013]. For details on how to contribute to this feature, please contact: Jeannette Murphy Senior Research Fellow University College London Centre for Health Informatics & Multiprofessional Education Wolfson House, 3rd Floor, 4 Stephenson Way London NW1 2HE, UK Tel.: +44 0203 549 5305 E-mail: j.murphy@ucl.ac.uk