DOI: 10.1111/hir.12055
Dissertations into practice
Abstract Outreach services are becoming more prevalent throughout the health library sector both in the UK and abroad, and they have the potential to impact on information support for evidence-based medicine. This article reports on a study which explored the perceptions of UK health library staff about the term ‘outreach’ and demonstrated that a variety of services are being offered under this umbrella term. Whilst practitioners are also divided over the impact of outreach services, many of them see this as key to future service developments. The study was completed by Rebecca Dorsett as part of her MSc in Information and Library Management at Northumbria University. She was supervised by Sue Childs and graduated in 2012 with a Distinction. Rebecca is now due to commence a new role as Information Support Officer for the Ministry of Defence. AM Keywords: evidence-based medicine; libraries, healthcare, library outreach; qualitative research; United Kingdom (UK)
bigger picture, amalgamating details of services throughout the UK. Traditional and more familiar models such as that of the Clinical Librarian role have been studied well,2 yet with so many changing job roles to accommodate organisational needs, many roles involved in similar work are being neglected in research projects. This overall aim of this research was to explore the attitudes and opinions towards outreach work within the health information and library sector in the UK and to assess current impacts and implications for future practice. Objectives: • To investigate what outreach services are in use in Health Libraries in the UK. • To discover what factors that shape each individual service. • To identify different methods of delivering outreach services. • To assess the impacts/role of outreach services in evidence-based medicine. Literature review
Outreach services in healthcare perceptions and impacts
libraries:
Rebecca Dorsett University of Northumbria Newcastle upon Tyne, NE1 8ST, UK [email protected] Context Outreach services are becoming more prevalent throughout the health library sector within the UK and abroad, and such services have a strong ability to impact the practice of evidence-based medicine. However, there are no clear definitions or models of outreach services followed within the UK. Studies describing individually tailored projects1 have been published, but there has been little research on the
Current literature highlights3 the growing number of outreach services within the NHS and indeed health library environments around the world. The literature also reveals differences in outreach methods being employed, professional roles and their working models, and the impact measures being implemented to try and measure the outcomes of library involvement, in particular within the context of evidence-based medicine (EBM). Despite the growing number of outreach services, one of the main points that came out of the literature review was that there was no clear definition of what constitutes outreach work. Many articles differed on what they considered to be outreach work, with some focussing on services that were provided to users physically away from their main library site.4 This lack of consensus
© 2014 The authors. Health Information and Libraries Journal © 2014 Health Libraries Group Health Information & Libraries Journal, 31, pp. 75–78
75
76
Dissertations into practice
was also true of the roles that encompass outreach work, and the literature mostly focussed upon job roles with the specific title of clinical librarian – as opposed to other roles that did not hold this title.5 The literature also revealed that there are widely varying impact measurement tools and procedures being used throughout the country and that more national impact measurement methods need to be used to group together national statistics and make a strong case for the work of information professionals.3 Research methods Two different methods were initially chosen to use within this study which comprised of an initial electronic survey followed by e-mail interviews to build upon the data gathered from the survey group. The aim of the study was to obtain data from health library services throughout the UK, as opposed to studies that had previously targeted specific job roles. Initially, only NHS libraries were considered for the sample set to be used for the survey, but this was expanded to include all libraries involved in the healthcare sector, including private organisations and charities. At data analysis stage, this approach enabled comparisons to be made across and between sectors. The survey was distributed using data from the Health Library & Information Services Directory (HLISD), a directory of health libraries throughout the UK, and two e-mail discussion lists (Health Libraries Group (HLG) & LIS-Medical). Survey The initial survey period was planned to run for a total of 14 days. This period was based on the feedback of the sample as many staff were found to be in part-time employment or working a variety of shifts. When this survey period was over, an e-mail was distributed, thanking respondents for their participation. The online survey, however, remained open, and it was found that many more library staff participated in the online survey after the survey period had technically ended. The number of participants therefore dramatically increased
over a further 2-week period, highlighting that a longer survey period involving this target audience of staff can have a large impact on response rates, a point highlighted in a previous study by Childs.6 The survey received 270 responses in total. Survey follow-up Participants were asked whether they would like to participate in further informal interviews via telephone or provide further information via e-mail. The aim was to gather more personal insight from a sample of job roles to encourage participants to discuss their own experiences and offer opinions. Of those participants who completed the questionnaire, 54 respondents agreed to share further information and they were given the option of communication via e-mail or via telephone. The overall majority responded with a preference for e-mail communication. This response to providing information was telling in itself, highlighting the choice of survey distribution using online methods to be an apt one for the target audience. Markham7 makes the point that ‘e-mail interviews may be better suited to participants who have busy schedules and desire time to consider their responses’, which seemed to be appropriate with this sample group. An e-mail was distributed to a sample of twenty respondents from this group, and they were given 7 days to return the responses. The e-mail encouraged users to treat their response as if it was a conversation, with no long thought out statements and perfect answers. Each participant was asked to express their own thoughts, opinions and experiences surrounding outreach services in as much detail as they wished. A total of 15 open-ended questions were included within the e-mail but were highlighted as ‘suggested considerations’ to be included in the responses, not specific questions to be answered to ensure that the participants felt they could include personal opinions and also to analyse what issues they thought important by discerning how much text they devoted to each issue and to see which ones were not touched open or deemed important by the individuals.
© 2014 The authors. Health Information and Libraries Journal © 2014 Health Libraries Group Health Information & Libraries Journal, 31, pp. 75–78
Dissertations into practice
Results and discussion
Survey follow-up
Survey
The main points to come out of the follow-up e-mails were as follows: • Outreach services will become the main method of delivery for library services in the future • Outreach services have been affected by staffing levels and financial constraints • Building relationships with users can be a challenge • Promotion of the service is a key element of making outreach work • There is a perceived need to move away from traditional models and view of the library as a physical space and to take services into the users workplace • Outreach services run by one team or individual, often cover multiple libraries and trusts Participants were asked what services they thought should be classified under the term ‘outreach’. The results were similar to those of the survey, with respondents citing services such as literature searches, training sessions and those services that were delivered outside of the physical library space. ‘Outreach’ was identified as being a large part of the library team’s overall workload, and there are often dedicated outreach staff to be found within a trust. One of the key issues mentioned in all the responses was the importance of moving out of the library space in a physical sense, a point that was also raised in the survey, with some participants stating that they believed outreach services were those conducted outside of the library itself. The issues surrounding job titles and roles were raised by several of the participants. One participant commented upon their job title being new to the organisation and that the role needed to be explained and promoted to users who did not know how the service could benefit them. Another stated that there was no funding for the specific role of an Outreach Librarian. The main group that was mentioned by participants as using outreach services were doctors. Impact measures were briefly mentioned, but whilst methods to measure impact such as the SHALL methodology8 (now LKSL) were in use, participants were unsure of their value.
The key figures drawn from the survey were as follows: • 78.1% (211) of respondents believed they provided outreach services • Database training, clinical librarians and current awareness bulletins were the top services classed as outreach by those who believed the provided outreach • The two largest factors seen to influence outreach services are staffing levels and financial constraints. • 71.1% (192) respondents answered that they did not believe outreach services could have an impact on evidence-based medicine. • 43.7% (118) respondents answered they had impact measures in place to measure outreach services with the most popular tool being a questionnaire. • 67% (181) of respondents stated that that the staff involved in their outreach services were mainly qualified professionals. The survey provided a wide range of both qualitative and quantitative data on what health library staff perceive as ‘outreach’ and what is currently being provided in health libraries throughout the UK. Many of the results support the existing literature, such as the main users of such service being found to be nurses and the large scope of outreach-related library and information job roles that exist within the UK. It is interesting, as noted above, that over 70% of respondents felt that outreach services did not have an impact in evidence-based medicine. The survey analysis showed a correlation between this finding and the size of a team along with the impact measures in place. This may partially explain this finding, with many practitioners struggling to find the time to implement impact measures in their own workplaces. The finding is also related to the definition of outreach, because those with a Clinical Librarian within the team were more likely to say that they did feel there was an impact – as opposed to staff who provided services such as literature searches. In fact, opinion was divided over whether the provision of literature searches should be considered outreach work.
© 2014 The authors. Health Information and Libraries Journal © 2014 Health Libraries Group Health Information & Libraries Journal, 31, pp. 75–78
77
78
Dissertations into practice
Conclusion and implications for practice Many research participants felt that outreach services will become the main method of delivery for library services in the future. This has major implications for the future design and planning of services and for the future provision of both library budgets and training. Outreach will need to be considered as a large part of future practitioners’ job roles within the health sector, whether those roles are created entirely for this purpose or whether teams as a whole contribute to provide outreach services. As a result of this, technology will also need to be better implemented and explored amongst practitioners to create a wide range of outreach services and extend the current reach of practitioners further afield and across a wider range of platforms. Technology will also help streamline and improve outreach services for those practitioners already involved in outreach work. Changes in and increased use of different technologies will also affect the future of the library as a physical space. How the space is utilised and its relevance in providing the best services and resources for both practitioners and library users will undoubtedly have an impact on how much funding is allocated to physical resources. A need for impact measurement has also been shown. This will need to be implemented throughout the sector in order to gain valuable insight into the impact of outreach services and best practice methods, whilst also providing valuable evidence of the work of information practitioners and their impact within the wider healthcare sector. This will also provide valuable information for practitioners at a local level about what services are most valued by their users and how resources can best be allocated to provide the most appropriate levels of service. Promotion and marketing of health library services and the lack of understanding of the information professionals role and available skills has been a worrying revelation to have emerged from this research, and this is an area that has the potential to be explored further to establish any possible means of being able to ensure that healthcare professionals are fully utilising the
services available to them. This links in with the value that library services have within organisations, and more work is needed here to prove this, particularly in such times of change for organisations such as the NHS. The value of libraries needs to be demonstrated more than ever in such circumstances not only for the cost-effectiveness impacts that they can have within organisations, but for the role that they can play in helping healthcare staff and, ultimately, the patients. References 1 Maden-Jenkins, M. Case study 6:1 clinical information specialist. In: Brettle, A. & Urquhart, C. (eds). Changing Roles and Contexts for Health Library & Information Professionals. London: Facet Publishing, 2012: 95–97. 2 Sargeant, S. & Harrison, J. Clinical librarianship in the UK: temporary trend or permanent profession? Part I: a review of the role of the clinical librarian. Health Information and Libraries Journal 2004, 21, 173–181. 3 Cimpl, K. Clinical medical librarianship: a review of the Literature. Bulletin of the Medical Library Association 1985, 73, 21–28. 4 Fama, J., Berryman, D., Harger, N., Julian, P., Peterson, N., Spinner, M. & Varney, J. Inside outreach: a challenge for health sciences librarians. Journal of the Medical Library Association, 2005, 93, 327–334. 5 Scherrer, C. S. Reference librarians’ perceptions of the issues they face as academic health information professionals. Journal of the Medical Library Association 2004, 92, 226–232. 6 Childs, S. M. A survey of nursing libraries in the Northern region. Health Libraries Review 1994, 11, 3–28. 7 Markham, A. N. Internet communication as a tool for qualitative research. In: Silverman, D. (ed). Qualitative Research: Theory, Method and Practice, 2nd edn. London: Sage, 2004: 95–124. 8 NHS Library Services (England) [Internet]. Impact toolkit. Accessible at: http://www.libraryservices.nhs.uk/forlibrary staff/impactassessment/impact_toolkit.html (Accessed: 25 November 2013) Received 25 November 2013; Accepted 17 December 2013
For details on how to contribute to this feature please contact: Audrey Marshall Watts Building, Lewes Road Brighton BN2 4GJ, UK Tel: 01273 642420 E-Mail: [email protected]
© 2014 The authors. Health Information and Libraries Journal © 2014 Health Libraries Group Health Information & Libraries Journal, 31, pp. 75–78
Dissertations into practice
Abstract Outreach services are becoming more prevalent throughout the health library sector both in the UK and abroad, and they have the potential to impact on information support for evidence-based medicine. This article reports on a study which explored the perceptions of UK health library staff about the term ‘outreach’ and demonstrated that a variety of services are being offered under this umbrella term. Whilst practitioners are also divided over the impact of outreach services, many of them see this as key to future service developments. The study was completed by Rebecca Dorsett as part of her MSc in Information and Library Management at Northumbria University. She was supervised by Sue Childs and graduated in 2012 with a Distinction. Rebecca is now due to commence a new role as Information Support Officer for the Ministry of Defence. AM Keywords: evidence-based medicine; libraries, healthcare, library outreach; qualitative research; United Kingdom (UK)
bigger picture, amalgamating details of services throughout the UK. Traditional and more familiar models such as that of the Clinical Librarian role have been studied well,2 yet with so many changing job roles to accommodate organisational needs, many roles involved in similar work are being neglected in research projects. This overall aim of this research was to explore the attitudes and opinions towards outreach work within the health information and library sector in the UK and to assess current impacts and implications for future practice. Objectives: • To investigate what outreach services are in use in Health Libraries in the UK. • To discover what factors that shape each individual service. • To identify different methods of delivering outreach services. • To assess the impacts/role of outreach services in evidence-based medicine. Literature review
Outreach services in healthcare perceptions and impacts
libraries:
Rebecca Dorsett University of Northumbria Newcastle upon Tyne, NE1 8ST, UK [email protected] Context Outreach services are becoming more prevalent throughout the health library sector within the UK and abroad, and such services have a strong ability to impact the practice of evidence-based medicine. However, there are no clear definitions or models of outreach services followed within the UK. Studies describing individually tailored projects1 have been published, but there has been little research on the
Current literature highlights3 the growing number of outreach services within the NHS and indeed health library environments around the world. The literature also reveals differences in outreach methods being employed, professional roles and their working models, and the impact measures being implemented to try and measure the outcomes of library involvement, in particular within the context of evidence-based medicine (EBM). Despite the growing number of outreach services, one of the main points that came out of the literature review was that there was no clear definition of what constitutes outreach work. Many articles differed on what they considered to be outreach work, with some focussing on services that were provided to users physically away from their main library site.4 This lack of consensus
© 2014 The authors. Health Information and Libraries Journal © 2014 Health Libraries Group Health Information & Libraries Journal, 31, pp. 75–78
75
76
Dissertations into practice
was also true of the roles that encompass outreach work, and the literature mostly focussed upon job roles with the specific title of clinical librarian – as opposed to other roles that did not hold this title.5 The literature also revealed that there are widely varying impact measurement tools and procedures being used throughout the country and that more national impact measurement methods need to be used to group together national statistics and make a strong case for the work of information professionals.3 Research methods Two different methods were initially chosen to use within this study which comprised of an initial electronic survey followed by e-mail interviews to build upon the data gathered from the survey group. The aim of the study was to obtain data from health library services throughout the UK, as opposed to studies that had previously targeted specific job roles. Initially, only NHS libraries were considered for the sample set to be used for the survey, but this was expanded to include all libraries involved in the healthcare sector, including private organisations and charities. At data analysis stage, this approach enabled comparisons to be made across and between sectors. The survey was distributed using data from the Health Library & Information Services Directory (HLISD), a directory of health libraries throughout the UK, and two e-mail discussion lists (Health Libraries Group (HLG) & LIS-Medical). Survey The initial survey period was planned to run for a total of 14 days. This period was based on the feedback of the sample as many staff were found to be in part-time employment or working a variety of shifts. When this survey period was over, an e-mail was distributed, thanking respondents for their participation. The online survey, however, remained open, and it was found that many more library staff participated in the online survey after the survey period had technically ended. The number of participants therefore dramatically increased
over a further 2-week period, highlighting that a longer survey period involving this target audience of staff can have a large impact on response rates, a point highlighted in a previous study by Childs.6 The survey received 270 responses in total. Survey follow-up Participants were asked whether they would like to participate in further informal interviews via telephone or provide further information via e-mail. The aim was to gather more personal insight from a sample of job roles to encourage participants to discuss their own experiences and offer opinions. Of those participants who completed the questionnaire, 54 respondents agreed to share further information and they were given the option of communication via e-mail or via telephone. The overall majority responded with a preference for e-mail communication. This response to providing information was telling in itself, highlighting the choice of survey distribution using online methods to be an apt one for the target audience. Markham7 makes the point that ‘e-mail interviews may be better suited to participants who have busy schedules and desire time to consider their responses’, which seemed to be appropriate with this sample group. An e-mail was distributed to a sample of twenty respondents from this group, and they were given 7 days to return the responses. The e-mail encouraged users to treat their response as if it was a conversation, with no long thought out statements and perfect answers. Each participant was asked to express their own thoughts, opinions and experiences surrounding outreach services in as much detail as they wished. A total of 15 open-ended questions were included within the e-mail but were highlighted as ‘suggested considerations’ to be included in the responses, not specific questions to be answered to ensure that the participants felt they could include personal opinions and also to analyse what issues they thought important by discerning how much text they devoted to each issue and to see which ones were not touched open or deemed important by the individuals.
© 2014 The authors. Health Information and Libraries Journal © 2014 Health Libraries Group Health Information & Libraries Journal, 31, pp. 75–78
Dissertations into practice
Results and discussion
Survey follow-up
Survey
The main points to come out of the follow-up e-mails were as follows: • Outreach services will become the main method of delivery for library services in the future • Outreach services have been affected by staffing levels and financial constraints • Building relationships with users can be a challenge • Promotion of the service is a key element of making outreach work • There is a perceived need to move away from traditional models and view of the library as a physical space and to take services into the users workplace • Outreach services run by one team or individual, often cover multiple libraries and trusts Participants were asked what services they thought should be classified under the term ‘outreach’. The results were similar to those of the survey, with respondents citing services such as literature searches, training sessions and those services that were delivered outside of the physical library space. ‘Outreach’ was identified as being a large part of the library team’s overall workload, and there are often dedicated outreach staff to be found within a trust. One of the key issues mentioned in all the responses was the importance of moving out of the library space in a physical sense, a point that was also raised in the survey, with some participants stating that they believed outreach services were those conducted outside of the library itself. The issues surrounding job titles and roles were raised by several of the participants. One participant commented upon their job title being new to the organisation and that the role needed to be explained and promoted to users who did not know how the service could benefit them. Another stated that there was no funding for the specific role of an Outreach Librarian. The main group that was mentioned by participants as using outreach services were doctors. Impact measures were briefly mentioned, but whilst methods to measure impact such as the SHALL methodology8 (now LKSL) were in use, participants were unsure of their value.
The key figures drawn from the survey were as follows: • 78.1% (211) of respondents believed they provided outreach services • Database training, clinical librarians and current awareness bulletins were the top services classed as outreach by those who believed the provided outreach • The two largest factors seen to influence outreach services are staffing levels and financial constraints. • 71.1% (192) respondents answered that they did not believe outreach services could have an impact on evidence-based medicine. • 43.7% (118) respondents answered they had impact measures in place to measure outreach services with the most popular tool being a questionnaire. • 67% (181) of respondents stated that that the staff involved in their outreach services were mainly qualified professionals. The survey provided a wide range of both qualitative and quantitative data on what health library staff perceive as ‘outreach’ and what is currently being provided in health libraries throughout the UK. Many of the results support the existing literature, such as the main users of such service being found to be nurses and the large scope of outreach-related library and information job roles that exist within the UK. It is interesting, as noted above, that over 70% of respondents felt that outreach services did not have an impact in evidence-based medicine. The survey analysis showed a correlation between this finding and the size of a team along with the impact measures in place. This may partially explain this finding, with many practitioners struggling to find the time to implement impact measures in their own workplaces. The finding is also related to the definition of outreach, because those with a Clinical Librarian within the team were more likely to say that they did feel there was an impact – as opposed to staff who provided services such as literature searches. In fact, opinion was divided over whether the provision of literature searches should be considered outreach work.
© 2014 The authors. Health Information and Libraries Journal © 2014 Health Libraries Group Health Information & Libraries Journal, 31, pp. 75–78
77
78
Dissertations into practice
Conclusion and implications for practice Many research participants felt that outreach services will become the main method of delivery for library services in the future. This has major implications for the future design and planning of services and for the future provision of both library budgets and training. Outreach will need to be considered as a large part of future practitioners’ job roles within the health sector, whether those roles are created entirely for this purpose or whether teams as a whole contribute to provide outreach services. As a result of this, technology will also need to be better implemented and explored amongst practitioners to create a wide range of outreach services and extend the current reach of practitioners further afield and across a wider range of platforms. Technology will also help streamline and improve outreach services for those practitioners already involved in outreach work. Changes in and increased use of different technologies will also affect the future of the library as a physical space. How the space is utilised and its relevance in providing the best services and resources for both practitioners and library users will undoubtedly have an impact on how much funding is allocated to physical resources. A need for impact measurement has also been shown. This will need to be implemented throughout the sector in order to gain valuable insight into the impact of outreach services and best practice methods, whilst also providing valuable evidence of the work of information practitioners and their impact within the wider healthcare sector. This will also provide valuable information for practitioners at a local level about what services are most valued by their users and how resources can best be allocated to provide the most appropriate levels of service. Promotion and marketing of health library services and the lack of understanding of the information professionals role and available skills has been a worrying revelation to have emerged from this research, and this is an area that has the potential to be explored further to establish any possible means of being able to ensure that healthcare professionals are fully utilising the
services available to them. This links in with the value that library services have within organisations, and more work is needed here to prove this, particularly in such times of change for organisations such as the NHS. The value of libraries needs to be demonstrated more than ever in such circumstances not only for the cost-effectiveness impacts that they can have within organisations, but for the role that they can play in helping healthcare staff and, ultimately, the patients. References 1 Maden-Jenkins, M. Case study 6:1 clinical information specialist. In: Brettle, A. & Urquhart, C. (eds). Changing Roles and Contexts for Health Library & Information Professionals. London: Facet Publishing, 2012: 95–97. 2 Sargeant, S. & Harrison, J. Clinical librarianship in the UK: temporary trend or permanent profession? Part I: a review of the role of the clinical librarian. Health Information and Libraries Journal 2004, 21, 173–181. 3 Cimpl, K. Clinical medical librarianship: a review of the Literature. Bulletin of the Medical Library Association 1985, 73, 21–28. 4 Fama, J., Berryman, D., Harger, N., Julian, P., Peterson, N., Spinner, M. & Varney, J. Inside outreach: a challenge for health sciences librarians. Journal of the Medical Library Association, 2005, 93, 327–334. 5 Scherrer, C. S. Reference librarians’ perceptions of the issues they face as academic health information professionals. Journal of the Medical Library Association 2004, 92, 226–232. 6 Childs, S. M. A survey of nursing libraries in the Northern region. Health Libraries Review 1994, 11, 3–28. 7 Markham, A. N. Internet communication as a tool for qualitative research. In: Silverman, D. (ed). Qualitative Research: Theory, Method and Practice, 2nd edn. London: Sage, 2004: 95–124. 8 NHS Library Services (England) [Internet]. Impact toolkit. Accessible at: http://www.libraryservices.nhs.uk/forlibrary staff/impactassessment/impact_toolkit.html (Accessed: 25 November 2013) Received 25 November 2013; Accepted 17 December 2013
For details on how to contribute to this feature please contact: Audrey Marshall Watts Building, Lewes Road Brighton BN2 4GJ, UK Tel: 01273 642420 E-Mail: [email protected]
© 2014 The authors. Health Information and Libraries Journal © 2014 Health Libraries Group Health Information & Libraries Journal, 31, pp. 75–78
