South Central Study Day 1 st February 2011 Debra Thornton Library & Knowledge Services Manager Blackpool Teaching Hospitals Foundation Trust

 Successful clinical librarian service ◦ Obs / Gyn MDT ◦ A&E Clinical Governance ◦ Cardiac Clinical Governance ◦ Practice Development Nurses

Requested by: Intended use of the information:

Requested by: Intended use of the information:

Requested by: Intended use of the information:

Understand context Establish relationship Offer searches relevant to discussion Query impact Searches requested Full integration

“Effective HRM practices can reduce mortality in hospitals”

“Like detergent, the word ‘librarian’ is an accurate description of function, but not a value proposition” (Janice Lachance. Information Outlook 2009) Board librarian Management Information Specialist Management Information Consultant Business Intelligence Librarian We chose MANAGEMENT LIBRARIAN – and were very glad we did

A LEARNING ORGANISATION Continuous improvementEmpowerment University Hospital Stimulate innovation Develop leaders Aligned with Trust Objectives

Management Librarian A ‘leap of faith’

What can the Service offer the Trust?  Management Librarian to work with management teams throughout the Trust  Ensure that decision making at the highest level is evidence based and supported by relevant knowledge and information  The service enables access to this knowledge store at the exact time it is required  The service is a personal service provided at the point of need – by telephone request, by or in person at meetings  Librarian attendance at Board and other meetings engenders a culture of evidence based decision making in a non-clinical setting  Provide high quality evidence of new developments and practices that have proven to show benefits in terms of improved quality services and financial gains.

Impact of The Service:  Trust Board of Directors  Executive Directors/Divisional Directors Meeting  Change Management Group Meeting  Associate Directors of Operations Meeting  Directorate Managers Meeting Senior Management Meetings:

Impact of The Service:  Attendance at senior management meetings has resulted in information searches taking place on some of the following topics:  Recruitment of Nurses – Examples of best practice  Closing Wards to Improve Healthcare  Trusts publishing their own data to the publicTrusts publishing their own data to the public  Examples of best practice around the patient experience

Trusts publishing their own data to the public

Stories ‘are a way to teach, inspire, persuade, and share information’. ‘Patient stories can be effective as a tool for informing the service planning process’ Question: How can we share patient experiences with our staff?

Includes:  Chief Executive  Associate Directors of Operations  Associate Director of Corporate Affairs  Assistant Director of Strategic Development  Deputy Director of HR and OD  Assistant Director of Pharmacy  Director of Finance  Director of Nursing & Quality  Utilisation of the Service by managers : Impact of The Service:

Chief Executive’s Blog There is already evidence around, that for instance by reducing patient infections you can provide better care for patients at a lower cost. I have had Trevor Morris, our management librarian looking in to this, and I attach an Evidence Search - Quality & Cost, which starts to explore these issues. It is worth dipping in to some of these articles, as it is the philosophy of quality and financial effectiveness that we will be basing our plans on over the next few years.Evidence Search - Quality & Cost

 Supporting QuIPP Impact of The Service: Carry out review of the evidence base in relation to the proposed business case:  Looking at current legislation and national guidance  Review of all published research in the area  Review of peer-reviewed content  Identifying similar implementations  Highlighting if the work has been done elsewhere  Identify successful implementation  Identify lessons learned  Provide contacts that have gone through the process Potential for the evidence base to impact on business case by :

‘Cost of MRSA and MSSA infections or bacteraemia’ Methicillin-Sensitive Staphylococcus Aureus (MSSA) Screening Programme QuIPP Example:  Evidence search for CSS Division in December 2009:

‘By screening for MSSA at the same time as we screen for MRSA it is expected that we will be able to reduce infection rates and improve patient safety. Were we to achieve similar rates for the reduction of all MSSA infections as we achieved against MRSA bacteraemias (40%), within the first year a net cost saving of £0.3m million could be achieved by savings in from reductions in length of stay’ (Business case for MSSA screening programme, March 2010) QuIPP Examples:  Clinical Pathway for MSSA Screening Programme now been produced.  Looking to submit it for national recognition.

Management Search Procedure:

Main Sources consulted:  Emerald Collection of Management Resources  NHS Evidence - Specialist Health Management Collection  NHS Institute for Innovation and Improvement  NHS Economic Evaluation Database (NHS EED)  Intute: Business and management Studies  Health Business Elite Database  Health Management Information Consortium (HMIC)  Google Scholar  Google

Sources Consulted

Advanced Search

Impact of The Service: Attendance at senior management meetings has resulted in information searches taking place on some of the following topics:  Recruitment of nurses – examples of best practice  Closing wards to improve healthcare  Integrating the culture of two organisations during a merger  Student experiences in the clinical setting  Restructuring hospital departments to reflect care pathways

Restructuring Hospital Departments to reflect Care Pathways

Supporting Clinical Pathways  Service has been involved in the utilisation and promotion of the Map of Medicine across the Trust.  Currently supports the process of developing localised clinical pathways in the Hospital in the following stages: 1. Select and prioritise a topic that is important for your service.  The Service performs a search on current pathways and guidelines. 2. Gather information to underpin the pathway development  Provide an expert literature search of the evidence base  Provide examples of other hospital experiences

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New process for developing clinical pathways:  Streamlined process cycle  Virtual review of proposed pathways without waiting for monthly meeting with audit trail  Support and co-ordinate pathway development  Harnessing tools such as SharePoint and Map of Medicine  Supports whole system pathways across the health community  Pathways will now link to the Trusts new £30m EPR system called ALERT

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What’s in a name? Management Librarian (QuIPP Project) Clinical Pathways Manager

40 Over 78% of people said they don’t have time to find the information they need. “Clinical practice is far too busy” Where do people look for information?

Was the librarian’s summary accurate / useful?

What was the information used for?

 “We have taken some operating procedures out of the operating theatre and put them into a community clean/clinic room”  “The information identified that investigations from incidents is essential and lessons learned must be implemented in order to prevent incidents occurring again.”  “The information provided useful links and details of authors where I could search for these further articles. I think the service is an excellent provision and it has helped me tremendously with my research.”

Evolution of the Service:  Personalised horizon scanning for senior managers in each division based on their KPI’s  Develop an Intranet hosted database of completed searches, beneficial for identifying what kinds of management questions are asked most often and which questions lack satisfactory answers.  Development of the Management Librarian role to Clinical Pathways Manager  Continuation of the Management Librarian Service by the Library team ‘It is clear that the service is helping us to make better, more evidence based decisions, and supporting better quality care for patients.’ (Aidan Kehoe, CE, 27 th May 2010)

Evidence: NICE (2010) Chest pain of recent onset: Assessment and diagnosis of recent onset chest pain or discomfort of suspected cardiac origin.Chest pain of recent onset: Assessment and diagnosis of recent onset chest pain or discomfort ofsuspected cardiac origin European Association of Echocardiography (2009) Stress echocardiography expert consensus statement Stress echocardiography expert consensus statement Further resources for patients: Patient UK (2010) Exercise electrocardiogram (ECG)Exercise electrocardiogram (ECG) EXERCISE STRESS TESTING

Debra Thornton Library & Knowledge Services Manager Trevor Morris Clinical Pathways Manager