The Value Study as a Tool for Library Advocacy National Network of Libraries of Medicine Boost Box, August 12, 2014 Joanne Gard Marshall Alumni Distinguished Professor School of Information & Library Science University of North Carolina Julia Sollenberger, Assoc. VP and Director Medical Center Libraries & Technologies r University of Rochester Medical Center

Purpose: Highlight YOUR library and its value in your organization

JMLA article

Study Team NN/LM MAR Planning Team Julia Sollenberger, Chair, University of Rochester Medical Center Susan K. Cavanaugh, UMDNJ Camden Sharon Easterby-Gannett, Christiana Care Medical Libraries Sue Hunter, NN/LM MAR Mary Lou Klem, Health Sciences Library System, University of Pittsburgh Lynn Kasner Morgan, Mount Sinai Medical Center Kate Oliver, NN/LM MAR Neil Romanosky, NN/LM MAR UNC Research Team Joanne Gard Marshall, UNC Principal Investigator Cheryl A. Thompson, Project Manager Jennifer Craft Morgan Marshica Stanley Amber Wells

The Value Study was a partnership of the National Network of Libraries of Medicine, Middle Atlantic Region (NN/LM MAR) and the University of North Carolina at Chapel Hill (UNC). This project has been funded in part with federal funds from the National Library of Medicine, National Institutes of Health, Department of Health and Human Services, under Contract #N01-LM from New York University, NN/LM MAR. Additional support was provided by the Hospital Library Section of the Medical Library Association (MLA), the NY/NJ Chapter of MLA; the Philadelphia Chapter of MLA; the Upstate New York and Ontario Chapter of MLA; the New York State Reference and Research Library Resources Councils and the Donald Lindberg Research Fellowship from MLA. Analysis for this presentation was conducted by Joanne Gard Marshall, Jennifer Craft Morgan, Cheryl Thompson and Amber Wells. Acknowledgements

56 Health Libraries serving 118 Hospitals September 2010 – May 2011

Survey of physicians, residents, and nurses In-depth follow-up interviews with 24 survey respondents 16,122 physicians, residents, nurses.

Critical Incident Technique

Did you handle any aspect of the clinical situation differently as a result of having the information? Percent answering definitely or probably yes

Changes in Patient Care Changes Reported Attending Physicians ResidentsNurses Advice given to patient or family 47%45%48% Choice of drugs46%52%15% Choice of other treatments 42%43%17% Diagnosis36%42%9% Choice of test35%40%7% Post-hospital treatment 12%15%12% Length of stay7%11%6%

Resulted in a better informed clinical decision

SAVED ME TIME

Adverse Events Avoided as a Result of the Information Adverse Event Avoided Attending PhysiciansResidentsNurses Additional tests or procedures29%32%7% Patient misunderstanding of disease 19%23%26% Misdiagnosis22%23%3% Adverse drug reaction or interaction 15%16%10% Medication error13%17%9% Patient mortality7%10%3%

Access to Info Resources Used Library website – 50% Institution’s Intranet – 52% Search engine such as Google – 37% Even when searching through Google, access to full-text articles happens on campus because institutional subscription is provided by Library Library (the place) – 19% Librarian or Library Staff – 14% Institution’s eRecord – 18%

Access data and results from Value Study website.

Ways to Use the Value Study Results and Data Present and publicize within your institution and community Frame conversations with administrators, budget folks Use/download the data; conduct additional analyses

Present and Publicize Use presentation-ready PowerPoint results Available at study website Non-participants could choose: Full study results, or Particular groups Evidence valid for any health sciences library Represents a broad range of types and sizes of libraries Represents perceptions of both physicians and nurses

Personalize Examples from study participants and non-participants Use your own “stories” to frame the study results Make it personal and relevant Emphasize selected data, depending on your needs and audience

Presentation – University of Rochester Presentation to Medical Center Leadership Team Used own results; similar to full study Same presentation to Library staff

Publicize – U. of Rochester Medical Center

Publicize – U. of Rochester (university-wide online newsletter) article

Publicize – U. of Pittsburgh

University of NC at Chapel Hill Prepare a presentation that speaks to your institution. Showed difference between full study results and their own results Put story on Library website linking to the full study poster and slide presentation on the MAR Value Study website

University of NC at Chapel Hill First meeting/orientation with new Chancellor and new Provost. Greatest impression made with Value Study results Able to talk about integration with Electronic Health Record. Provost said “It’s like having a librarian on your shoulder.” Strategic Planning for University Libraries. Help to convince non-medical librarians Outcome – included goal about access to info for health providers and consumers in state

Publicize– North Shore LIJ, Lenox Hill Hospital Sent JMLA article to top execs of hospital. Prompted one to stop by for a tour and discussion. “Thank you for sharing the article. It shows the value of having a medical library in a hospital like ours.” Used in budget discussions with finance chief. He said “Now this is what I need to see.” Sent to Patient Safety folks to highlight avoidance of adverse events and reduction in patient length of stay

Frame Conversations – NY South Central Regional Library Council 99-bed hospital had sent a non-renewal of membership in SCRLC. Decision reversed. 500-bed hospital decided not to hire an MLS librarian; library clerk became manager. Value Study data helped SCRLC make strong case for significant professional development for the library manager.

Related Publications: JAMA Viewpoint Article

JAMA Article – Rochester Community

Frame Conversations – Queens Hospital Center Discussion initiated by hospital leadership on Hospital Strategic Plan Librarian shared Value Study and JAMA article Discussed ways library was supporting mission (Continuous Improvement in Quality of Care and in Patient Experience and Engagement) Supporting Evidence-Based Practice Instruction Licensing Point of Care Resources Serving on Hospital-Wide Committees

Open Doors – Winthrop University Hospital, L.I. Question from Interventional Radiologist – “Did you see the article in JAMA?” Said he would talk to chief of Neuroscience Librarian invited to morning report Then to Stroke report; ICU Neuro report Chief slides keyboard to librarian and says “teach us something about PubMed” or “I was having trouble with this search…” Librarian has taken 2 MOOCs in neurology Librarian says it has “changed her professional life”

Results Presented in National AHEC Meeting Southeast Area Health Education Center InfoButtons – Library resources integrated in EHR New Hanover Regional Medical Center, Wilmington, NC Presentation used study results to emphasize value of information to national audience

JAMA Article – Other Examples “Just got off the phone with an associate dean who was extolling the points you make…” “Article sent to me by one of our hospitalists, and we are now in talks about a pilot.” “A physician ripped it out of his own JAMA issue and handed it to me at today’s hospital grand rounds, which I coordinate.”

JAMA Article – Other Examples From a librarian who was laid off from a large regional teaching hospital in May 2013 – “I will send this article to my prior employer and ask that they reconsider the value of having professional medical librarians on their staff. What little cost reduction they achieved will just lead to increased costs elsewhere including potential loss of life.”

JAMA Article – Other Examples “We have shared it with our administrators and will be highlighting it throughout our institution for the National Medical Librarians Month.” “I am filled with joy. Below is an I just sent to my CEO about the article. Thanks from the bottom of my heart.”

Use Value Study DATA Consider doing additional analyses Examples of using “time saved” data In two institutions, extrapolated to dollars saved Another institution used length of stay data and extrapolated to dollars saved Methodologies can differ. Make assumptions clear

Time Saved to Dollars Saved One participant institution With the most conservative assumptions, $1,179,552 per year saved One non-participant institution Used less conservative numbers, but in this hospital, $466,320 per year saved

Advanced Data Analysis Multivariate analysis Used statistical models to examine the impact of using the library, librarian and library-provided databases on key outcome measures such as time saved, number of changes made to patient care and number of adverse events Good News: Using the librarian and coming to the physical library increased the number of positive outcomes as did accessing the databases via the access routes provided by the library

Look for Additional Publications by Joanne Marshall and the UNC research team Nursing Data – Marshall, J., Morgan, J., Klem, M., Thompson, C., Wells, A., (August 2014) The Value of Library and Information Services in Nursing and Patient Care. OJIN: The Online Journal of Issues in Nursing Vol. 19 No. 3. DOI: /OJIN.Vol198No03PPT02 Physician Data – Marshall, J., Morgan, J., Thompson, C., Wells, A., (August 2014). Library and Information Services: Impact on Patient Care Quality. International Journal of Health Care Quality Assurance. Vol. 27 No. 7. In press. Canadian Data – Bartlett, J., Marshall, J. The Value of Library and Information Services in Patient Care: Canadian Results from an International Multisite Study. Association, 2013, 34(03): , Journal of the Canadian Health Libraries. DOI: /c13-063

Contact: Julia Sollenberger Joanne Marshall