1. National Clinical Librarian Impact Study
Cathryn James
Clinical Librarian
Pip Divall
Clinical Librarian Service Manager

2. Background July 2016 – HEE QIG created a Task & Finish group
Based on work by NW CLs & Alison Brettle
Twitter chat on #ukmedlibs on 15th March 2016
Chaired by Mic Heaton (Derby)
Group convened based on regional representation PD
Group membership
Helen Alper
Sue Robertson
Cathryn James
Pip Divall
Emily Hurt
Margaret Scarce
(Daniel McDonald – Australia)

3. Aim
To evaluate the impact of Clinical Librarian (CL) services in the National Health Service (NHS);
To identify examples of how the role of the CL has an impact in the NHS
To add value to the impact of CL across the UK. CJ
What were trying to find out?
Rich picture of the work we do
Get some good stories
Cathryn James, Derby Teaching Hospitals NHS Foundation Trust

4. Methods Using Brettle et al as a guide Mixed methods
Questionnaire & interviews
TaF group met in person and later through teleconference
Ethics approval from Derby Teaching Hospitals Foundation Trust (registered as an audit) CJ
Group membership
First meeting 5th Dec 2016
Louise Hull, University Hospitals of Leicester NHS Trust

5. What is a Clinical Librarian?
“Clinical librarians seek to provide quality assured information to health professionals at the point of need, to support clinical decision making.” 
HILL, P., Report of a national review of NHS health library services in England: From knowledge to health in the 21st century. Department of Health. PD
Peter Hill report reference
Discussion around this went back and forth, went with a pragmatic, open defintion, also used by Brettle.
Bennet Jones & Katie Barnard, North Bristol NHS Trust

6. Questionnaire phase Methods Amended from Brettle’s original work
Piloted in Derby & Leicester and further amended from feedback
Smart Survey for data collection CJ
Software used
No of questionnaires sent out
Lindsay Snell, Derby Teaching Hospitals NHS Foundation Trust

7. Questionnaire phase Results 1962 surveys sent out
697 questionnaires returned (35% response rate)
41 organisations
England, Wales, Scotland
91% of responses were related to literature searches CJ
Partial responses were included where enough data was available, 194 partials, 503 fully completed.
Response rate shows engagement of staff with the services – Leicester response rate was 50%
Australia: sent out 350, got 77 responses – 22% response rate
Other 10% were training sessions ands journal clubs
Yvonne Stubbington, St Helens and Knowsley Teaching Hospitals NHS Trust

8. Results: Survey Response by staff group
Questionnaire phase
Results: Survey Response by staff group
Not just for doctors! A broad mix of customers.

9. Results: How searches were received
Questionnaire phase
Results: How searches were received
Mostly through , potentially signifying a relationship with named librarians.
In person represents that CLs have a visible presence.

10. Questionnaire phase Question themes
Patient Centred Care & Health Outcomes
Decision Making & Evidence-based Practice
Clinical Decision Making & EBP
Continuing Professional Development
Supporting Research
Quality of Care & Service Development
Efficiency, Accountability & Safety PD

11. Results: Patient Centred Care and Health outcomes
Questionnaire phase
Results: Patient Centred Care and Health outcomes PD

12. Results: Quality of Care and Service Development
Questionnaire phase
Results: Quality of Care and Service Development PD

13. Results: Efficiency, Accountability and Safety
Questionnaire phase
Results: Efficiency, Accountability and Safety PD
48% demonstrating value for money
62% has or may to improve patient/staff safety.

14. Interview phase Methods
Semi-structured topic guide based on questionnaire
Purposive sampling
8 organisations undertook interviews
25 interviews with Clinical Staff CJ
Thanks to Karen Trifunovic here for the transcription work?
Thanks to Alison Brettle for providing training on interviewing technique
Chesterfield 2
Derby 10
Leicester 5
Weston 3
North Bristol 1
Buckinghamshire 2
Portsmouth 1
St Helens and Knowsley 1(part of original North West cohort?)
Sarah Sutton, University Hospitals of Leicester NHS Trust

15. Interview phase Data analysis All interviews transcribed
Thematic analysis of transcripts
Data triangulated by CJ
and PD CJ
CJ & PD independently and then triangulated
Thematic analysis of interview transcripts – still ongoing. Watch out for our paper!
Lisa Lawrence, Derby Teaching Hospitals NHS Foundation Trust

16. Results: Major themes identified
Interview phase
Results: Major themes identified
Improved patient experience
Improved clinical collaboration
Supporting innovative practice
Leadership and supervision
It is rare but actually having some evidence behind that to back me up and the biggest help was being able to counsel the patient and his family with them knowing that we had done our research. CJ
Improved patient experience – emotional support, individualised care, increased QoL, shared decision making
Came through in several question answers
Improved clinical collaboration
Local and national collaboration – evidence to share with clinical teams (Suzanne Dawson), Derby experience – respiratory journal club extended to other teams
Supporting innovative practice
Finding where gaps in research are & using best evidence for best outcome
Leadership and supervision
Surprising result – using the evidence to lead a team through change
A lot confirmed what we suspected, but some results were more surprising than others.

17. Results: Major themes identified
Interview phase
Results: Major themes identified
…led to me and Dr R. sitting down and coming up with a much more streamlined referral pathway and certainly from the community hospitals where I am mainly based I now wait 7 to 10 days to get a PEG in whereas previously it was taking weeks to sort out, so yes I think it has led to us then sitting down and going through a very focussed way of coming up with local guidelines.
Improved patient experience
Improved clinical collaboration
Supporting innovative practice
Leadership and supervision PD
Improved patient experience – emotional support, individualised care, increased QoL, shared decision making
Came through in several question answers
Improved clinical collaboration
Local and national collaboration – evidence to share with clinical teams (Suzanne Dawson), Derby experience – respiratory journal club extended to other teams
Supporting innovative practice
Finding where gaps in research are & using best evidence for best outcome
Leadership and supervision
Surprising result – using the evidence to lead a team through change
A lot confirmed what we suspected, but some results were more surprising than others.

18. Results: Major themes identified
Interview phase
Results: Major themes identified
Improved patient experience
Improved clinical collaboration
Supporting innovative practice
Leadership and supervision
As a result of the use of the oral care sponge, or the mouth care sponge, it has led to a decision in the organisation to remove it from our organisation
As it’s an ineffective tool, and that has led to a massive change in practice.
Improved patient experience – emotional support, individualised care, increased QoL, shared decision making
Came through in several question answers
Improved clinical collaboration
Local and national collaboration – evidence to share with clinical teams (Suzanne Dawson), Derby experience – respiratory journal club extended to other teams
Supporting innovative practice
Finding where gaps in research are & using best evidence for best outcome
Leadership and supervision
Surprising result – using the evidence to lead a team through change
A lot confirmed what we suspected, but some results were more surprising than others.

19. Results: Major themes identified
Interview phase
Results: Major themes identified
So off the back of the literature search, we then realised one of the things that we hadn’t
done was a peer-led support
scheme in the ED…currently ongoing, is a pilot where fifth-year students spend time in the emergency department with third-year medical students, to try and support them in their practice… it’s changed decision making in terms of trialling and intervention
Improved patient experience
Improved clinical collaboration
Supporting innovative practice
Leadership and supervision
Improved patient experience – emotional support, individualised care, increased QoL, shared decision making
Came through in several question answers
Improved clinical collaboration
Local and national collaboration – evidence to share with clinical teams (Suzanne Dawson), Derby experience – respiratory journal club extended to other teams
Supporting innovative practice
Finding where gaps in research are & using best evidence for best outcome
Leadership and supervision
Surprising result – using the evidence to lead a team through change
A lot confirmed what we suspected, but some results were more surprising than others.

20. Clinical Librarian Skills
What our users said about us
Relevant
Personal
Cheerful
Valuable
Reliable
Time Savers
Beneficial
Indispensable
Timely
Professional
Efficient
What our users said about the CLs

21. Limitations Potential for “oversurveying” our customers
Interpretation of who to send the surveys to
Lack of engagement from some regions
Potential interviewer bias CJ
North West potentially oversurveyed, but their survey returns were good. Recently participated in Brettle study so expected less interest and was pleasantly surprised.
The whole process has been a learning process for Pip & Cathryn!
Hannah Wood, Weston Area Health NHS Trust

22. Conclusions Data analysis ongoing Shown complexity of the CL role
CLs save the time of clinicians
We do make a difference in supporting evidence-based decision making PD
Emily Hurt, Lancashire Teaching Hospitals NHS Foundation Trust

23. Acknowledgements With thanks to… NHS HEE Quality and Impact Group
Alison Brettle & NW CLs
Interviewees & interviewers
Participating libraries
Karen Trifunovic and all transcribers
Keith Nockels, formerly University Hospitals of Leicester NHS Trust

24. Contact details Cathryn James, Clinical Librarian
Derby Teaching Hospitals Foundation Trust
Pip Divall, Clinical Librarian Service Manager
University Hospitals of Leicester NHS Trust