ICLC Birmingham June 2011

1. ICLC Birmingham June 2011 The Role of a Clinical Librarian: A Diffusion of Innovations Interpretation Lisa Lawrence Clinical Librarian, Derby Hospitals NHS Foundation Trust

2. The Role of a Clinical Librarian:A Diffusion of Innovations Interpretation Aims • Clinical librarianship as an innovation in UK health librarianship Postgraduate dissertation, submitted September 2010 • Reasons for the study • Rogers’ Diffusion of Innovations theory • Literature review • Methods • Findings • Conclusion • Any Questions?

3. The Role of a Clinical Librarian:A Diffusion of Innovations Interpretation Reasons for the study • Postgraduate dissertation. • Clinical librarian at Derby Hospitals – interested to know more about UK CL services. • Purpose - To investigate the role of the CL in the UK, within the context of Rogers’ Diffusion of Innovations theory. • Objectives - investigate roles, establish commonalities/disparities, gain a better understanding of current implementations through use of DOI. • Provide a picture of awareness levels of CL services and any consequent effects on diffusion and adoption of the role.

4. The Role of a Clinical Librarian:A Diffusion of Innovations Interpretation Rogers’ Diffusion of Innovations (DOI) Theory • Rogers, E. M. (2003). Diffusion of Innovations. (5th edition) New York: Simon & Schuster. “Getting a new idea adopted, even when it has obvious advantages, is difficult. Many innovations require a lengthy period of many years from the time when they become available to the time when they are widely adopted”

5. The Role of a Clinical Librarian:A Diffusion of Innovations Interpretation Rogers’ DOI Theory • Rogers describes an innovation as “an idea, practice or object that is perceived as new by an individual or other unit of adoption” • Rogers interprets diffusion as “the process in which an innovation is communicated through certain channels over time among the members of a social system. It is a special type of communication, in that the messages are concerned with new ideas. … The newness of the idea in the message content gives diffusion its special character”

6. The Role of a Clinical Librarian:A Diffusion of Innovations Interpretation Aspects of DOI Theory • Communication: Interpretation; Perception; Situation • Time • Adoption or Rejection • Innovation-decision process: Knowledge; Persuasion; Decision; Implementation; Confirmation. • Adopter-categories: Innovators; Early adopters; Early majority; Late majority; Laggards. • Rate of adoption

7. The Role of a Clinical Librarian:A Diffusion of Innovations Interpretation Aspects of DOI Theory • Measure of control over process? • Social system structure – e.g. hierarchical • Innovation decisions: - Optional innovation-decisions - Collective innovation-decisions - Authority innovation-decisions - Contingent innovation-decisions

8. Aspects of DOI Theory Consequences of adoption or rejection: 1. Desirable vs undesirable 2. Direct vs indirect 3. Anticipated vs unanticipated Characteristics of innovations: 1. Relative advantage 2. Compatibility 3. Complexity 4. Trialability 5. Observability The Role of a Clinical Librarian:A Diffusion of Innovations Interpretation

9. The Role of a Clinical Librarian:A Diffusion of Innovations Interpretation Aspects of DOI Theory • Rogers states: “Innovations that are perceived by individuals as having greater relative advantage, compatibility, trialability, and observability and less complexity will be adopted more rapidly than other innovations. Past research indicates that these five qualities are the most important characteristics of innovations in explaining rates of adoption”

10. The Role of a Clinical Librarian:A Diffusion of Innovations Interpretation DOI – a suitable framework • Evaluations of pilot projects saw CL services as an innovation • Are CL services diffusing in the UK? • DOI theory – suitable model to use

11. The Role of a Clinical Librarian:A Diffusion of Innovations Interpretation Literature Review • What is clinical librarianship? • Background of clinical librarianship: - USA experience - UK experience • “Typical” role of CL • All examined within the DOI framework

12. The Role of a Clinical Librarian:A Diffusion of Innovations Interpretation Literature Review – Conclusions “In terms of Rogers’ characteristics of innovations, the innovation of clinical librarianship in the UK offers a small body of evidence, currently suggesting • Relative advantage - Some indications of cost savings and more effective EBP. • Compatibility - Consistent with trends in healthcare and health librarianship. • Complexity - No consistent model of practice, perhaps making widespread roll-out more difficult? • Trialability - Multiple pilot projects allow opportunity for experimentation - perception of adaptability? • Observability - Accumulating evidence base helpful”

13. The Role of a Clinical Librarian:A Diffusion of Innovations Interpretation Literature Review – Conclusions • Some central recognition of importance of CL role. • UK CL projects mainly contingent innovation-decisions. • Widespread knowledge, but consequences of implementations require further understanding. - CL project evaluations consistently confirm Desirable aspects - Direct/Indirect changes (individual/social system) not yet entirely evident - Unclear exactly what Anticipated and Unanticipated consequences occur. • Further research is called for in order to clarify these issues.

14. The Role of a Clinical Librarian:A Diffusion of Innovations Interpretation Methods • Methods: Online questionnaire, Follow-up Focus Group Analyses undertaken using online survey software for quantitative data and thematic analysis for qualitative information. • Ethics: Approval from Research Governance Consent from organisations/participants Data protection/anonymisation

15. The Role of a Clinical Librarian:A Diffusion of Innovations Interpretation Methods • Online questionnaire Piloted, amended, then sent to potential 45 respondents • Focus group Smaller group, more detailed discussion, themes arising from questionnaire responses

16. The Role of a Clinical Librarian:A Diffusion of Innovations Interpretation Questionnaire Findings • Response Rate - 20 partial responses (44%) response rate - 17 complete responses (38%) response rate • Clinical Librarians - 70% respondents CL service established 3 years+ - 65% respondents involved in their service for up to 3 years - Some variation in job titles/job roles

17. The Role of a Clinical Librarian:A Diffusion of Innovations Interpretation Questionnaire Findings • CL Services - Core services and optional services - 7 respondents (36.8%) using “clinical champions” - Variety of teams as first team/dept. supported - Core services as initial provision - Not all current CLs aware of initial CL services - Initial services shaped according to clinician preference - 52% respondents indicated services changed over time - Clinician or library led changes

18. The Role of a Clinical Librarian:A Diffusion of Innovations Interpretation Questionnaire Findings • CL Opinions & Awareness of Perceptions of CL Services - Mixed opinions - General belief clinical teams/departments pleased - Less direct evaluation available - Feedback indicates services valued • Best aspects of CL services – greatest impact? - Literature searching core - Current awareness/training actually reaches more users? - Value of interaction in department

19. The Role of a Clinical Librarian:A Diffusion of Innovations Interpretation Questionnaire Findings • Effects on library - Library staff expectations of CL service changed over time - Changing situations, necessitate realistic service delivery - Modify and adapt service according to: - clinical teams needs/expectations - library staff needs/expectations - Generally not encountering unforeseen consequences

20. The Role of a Clinical Librarian:A Diffusion of Innovations Interpretation Questionnaire Findings • Service Users - Variety of staff and students - Heaviest users generally medical staff - Least usage among administrative/non-clinical staff - Some CLs (59.2%) indicate change in usage over time

21. The Role of a Clinical Librarian:A Diffusion of Innovations Interpretation Questionnaire Findings • Service developments - Small adaptations as required - No wholesale changes to service model - Progression to supporting more teams both library-led and clinician-led - Some services have plans for future development - Influence of external factors

22. The Role of a Clinical Librarian:A Diffusion of Innovations Interpretation Questionnaire Findings • Service awareness - CLs believe some service awareness in their organisation - No total unawareness - Only 1 respondent indicated complete awareness - Board level awareness in some organisations - CL perceptions or truth? - Actual knowledge or guesswork? - Further marketing of services required?

23. The Role of a Clinical Librarian:A Diffusion of Innovations Interpretation Questionnaire Findings • Advantages of CL services to teams and organisations  Time saving for clinical staff  Best use of each professional’s skills  Supports EBP  Supports a questioning culture  Better informed staff should lead to better patient care Awareness of need to prove the value of library services as a whole – need to demonstrate impact

24. The Role of a Clinical Librarian:A Diffusion of Innovations Interpretation Focus Group Findings • DOI Theme: Desirability, Adaptability, Trialability, Observability - Anticipated themes: Roles & Responsibilities, Tailoring - Emergent theme: Empowerment • All participants CLs by job title and role • All slightly different experience of clinical librarianship • All participants chose to tailor services • Although CLs sometimes feel undervalued, unproductive, also a sense of empowerment

25. The Role of a Clinical Librarian:A Diffusion of Innovations Interpretation Focus Group Findings • DOI Theme: Compatibility and Relative Advantage for Individual Teams and Wider Organisation - Anticipated themes: Advantages, External Influence • CLs save clinicians time! • Improving practice • Improving skills

26. The Role of a Clinical Librarian:A Diffusion of Innovations Interpretation Focus Group Findings • All participants felt role helps to market library – “public face”. • External circumstances/decisions have significant impact on decisions made within CL service. • Emphasise need to demonstrate the value of the service in a time of economic uncertainty.

27. The Role of a Clinical Librarian:A Diffusion of Innovations Interpretation Focus Group Findings • DOI Theme: Consequences – Anticipated & Unanticipated - Anticipated themes: Consequences • Accepted any consequences as natural outcomes of their work. Embraced outcomes positively, regardless of expectations and workload demands. • Participants identified the need for peer support, advice and to share practice as a consequence. Highlighted importance for sole CLs.

28. The Role of a Clinical Librarian:A Diffusion of Innovations Interpretation Focus Group Findings • DOI Theme: Perception / Awareness - Anticipated themes: Awareness Variation, Perception (CL) - Emergent themes: Awareness (Library), Perception (Library) • Library staff awareness can be problematic, some colleagues are aware, but no real understanding of aims/purpose. • Awareness variations – served departments better than wider organisation. • Acknowledged need to improve awareness, particularly with managerial staff and/or budget holders.

29. The Role of a Clinical Librarian:A Diffusion of Innovations Interpretation Focus Group Findings • Participants emphasised the need for wider representation • Participants suggested sometimes symptomatic of perceptions of library services as a whole. • CL services part of the whole library service, need that foundation to function effectively.

30. The Role of a Clinical Librarian:A Diffusion of Innovations Interpretation Summary Findings • CLs have varied job titles, roles and responsibilities. • The role is tailored according to the needs, requirements and desires of clinical teams and organisations. • CLs provide a quality role to their organisation. • CLs feel empowered in their roles • CLs understand the effects of external influences on their services. • Awareness levels vary, both at individual and organisational levels, and within and without the library. • Need to address perceptions of library services.

31. The Role of a Clinical Librarian:A Diffusion of Innovations Interpretation Conclusions • DOI theory provided a good framework for examination of CL services. Specific themes could be investigated. • Adaptable/trialable nature of the role – a strength (a relative advantage), rather than a weakness? Aiding diffusion of the innovation? • Relative advantage also in the quality role the CL fulfils. • UK CL projects remain contingent on other decisions. Emphasis on need to evidence and prove the value, impact and worth of the role. • Need to improve awareness and perceptions.

32. The Role of a Clinical Librarian:A Diffusion of Innovations Interpretation Any Questions?

33. The Role of a Clinical Librarian:A Diffusion of Innovations Interpretation Thank You • Huge thanks to all those who participated in my research project! • Thanks to all of you for listening today. • Further information: Lisa Lawrence Royal Derby Hospital Lisa.Lawrence4@nhs.net