The impact of a health library service upon patient care

1. The impact of a health library service upon patient care Christine Urquhart & Alison Weightman Aberystwyth University Cardiff University

2. Introduction Impact, performance, outcomes, standards�.so what? Background to the impact �toolkit� Aims and objectives of the impact project Further developments� �and Questions about �value� to customers

3. Impact and value� Impact of information obtained from a library service may: Improve decision making - the process and the actual decision Contribute to continuing professional development � with emphasis on patient care Systematic review (HILJ) showed that professionally led library services have an impact on health outcomes for patients and may lead to time savings for health care professionals

4. Impact, performance, outcomes, standards� Inputs (resources � people, money, materials) Produce Outputs (services supplied) Contribute Impacts � effect of service on individual(s) or organisation Outcomes � consequences of using outputs Value � perceived benefit Performance � how well does the service convert inputs to outputs? What impacts and outcomes result from inputs and outputs? Standards � what are the desired norms for inputs and outputs? Compliance with agreed norms?

5. Background to the impact toolkit Systematic review had made some suggestions for conducting an impact survey Other guidance in �Evidence-based information practice� (Booth & Brice) A research study was funded by National Knowledge Service to develop a pragmatic but reliable user survey included within a toolkit of advice, to estimate the impact of a health library (on patient care)

6. Questionnaires and interviews Use of validated questionnaires allows for: Further validation and testing of the questions Comparison between libraries Using interview schedules already tried and tested means that: Risks of omitting questions are reduced One less thing to worry about when planning a survey!

7. Research project outline Literature review to assess the evidence for sending reminders in questionnaire surveys Using coloured paper (and similar practical points when planning a survey) Trial of questionnaire at several different types of health library site Face validity checking of the interview schedule

8. What to do�and not to do On balance there appear to be benefits in including an incentive particularly a cash rather than a non-cash incentive (5 studies). The benefits of entry into a lottery draw are unclear (3 studies) as is the enclosure of a pen with a mailed questionnaire (2 studies). There is full consensus that two to three reminders are appropriate (7 studies) The effect of length is unclear but on balance a shorter questionnaire is likely to increase response rate (12 studies). The effect of colour is uncertain (4 studies) Personalised contact/ advanced notification/ personalised covering letter (8 studies) also likely to be beneficial. Minimal available literature suggests that a web based form will save time, both in survey administration and analysis, and response rates/quality of response appear to be comparable to or better than a paper based survey (3 studies)

9. What next? Presentation at HLG conference in Cardiff in July 2008 Some interest from the email list Testing in one region of England Further work on interview schedule by a Masters student (Aberystwyth) in an impact study (impact of library related to business objectives of the Trust) Adaptation of the questionnaire for a study in the South West of a PCT knowledge service � to help in strategic planning

10. Impact and standards? Relationship � if any? The National Service Framework is a new set of standards for NHS funded libraries in England. The standards framework focuses on three key business objectives: Commissioning Access Library/Knowledge Service Staffing The new standards are replace the Health Library and Information Confederation Standards and have been referenced to all major quality assessment programmes including: Standards for Better Health, NHS Litigation Authority, Health and Safety Executive The framework: enables robust quality assessment of the �service offer� provides the means for an internal assessment of library/knowledge services enables organisations to assess their level of compliance to national standards and demonstrate fitness of purpose that our 21st century health system demands provides a clear focus for action planning across all NHS organisations, driving forward a quality improvement plan, offering clarity of direction for service managers, and transparency of development to meet business and client need. The benefits and knowledge from the project will continue to be part of the library service�s quality assurance programme to drive the quality agenda forward. (PMT Manual Version 02, 2009)

11. Is assessment worth the effort? For standards (doing it good) Estimated hidden cost of Helicon is �1.5 million. The internal survey process for NSF assessment will be similar to Helicon. Plus cost for training Quality Leads and Surveyors �estimated �50K. The indicative cost for external survey management and accreditation award is �6Kper service. This excludes hidden cost of Quality Leads and Surveyors (expenses). (Source: presentation by Colin Davies and Tricia Ellis, 26 April 2008) For impact assessment (are we doing good) If external consultancy sought for part of the work � cost depends on amount of work, but could range from 2k to 5k. (source: recent grant costs )

12. Outcomes and impacts The problem with outcomes�. May depend on other factors beyond the control of the library and library staff � information sharing and exchange, for example Cause and effect difficult to establish Staff feeling more confident in their decision making � not much of an impact ? But this contributes to reduced risk (not necessary to change decision to have an impact!)

13. Outcomes and values If outcomes are favourable or not favourable � effect on perceived value of the library service? Customer expectations (e.g. student valuation of the success of their search � graded largely by how long it took them, not just the quality of the information obtained, and the learning process) Difficult to separate out the value of the information obtained from the perceived value of the library service? (implications for virtual services?)

14. Customer values� Standards document reflects perceived expectations? Marketing theory � concept of perceived value Complex! But need to think about: Functional value, social value, emotional value, desire for knowledge, context Means to an end, price based (conjoint analysis) Customer experience levels, utilitarian vs entertainment And a few more aspects as well Outcomes and impact assessment SHOULD give some greater insights into the values held by users � and hopefully some less frequent users as well

15. Conclusions Developing knowledge on impact assessment Slow but steady progress Toolkit provides a framework (replication ideal but not an absolute requirement?) Is it important? Yes, vital to informing strategic planning about customer needs, and customer values Yes, provides evidence that the library IS doing good (not just doing it good, which standards may assess)

16. References Weightman, A. L. & Williamson, J. (2005). The value and impact of information provided through library services for patient care: A systematic review. Health Information and Libraries Journal, 22, 4-25. Urquhart, C., Spink, S., Thomas, R., & Weightman, A. (2007). Developing a toolkit for assessing the impact of health library services on patient care. Aberystwyth: Aberystwyth University, Available from CADAIR, http://hdl.handle.net/2160/355 Weightman, A., Urquhart, C., Spink, S., & Thomas, R. (2008). The value and impact of information provided through library services for patient care: developing guidance for best practice. Health Information and Libraries Journal, 26, 63-71. S�nchez-Fern�ndez, R., & Iniesta-Bonilla, M. A. (2007). The concept of perceived value: a systematic review of the research. Marketing Theory, 7, 427-451. Poll, R., & Payne, P. (2006). Impact measures for libraries and information services. Library Hi-Tech, 24(4), 547-562. Markless, S., & Streafield, D. (2006). Evaluating the impact of your library. London: Facet.