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Summary

Introduction

This chapter looks forward and examines the changing context of health care and how this may affect health information professionals. It also reflects how health has changed over the last 15 years and the corresponding changes that health information professionals have made.

THE HEALTH CONTEXT

Christine Urquhart

Introduction – future changes in health care

Trying to predict the future is always difficult. For health care, we have some help from a report produced by the Foresight Panel established to predict health care trends for 2020, and provide recommendations for action by the UK government (Department of Trade and Industry, 2000). By the end of 2010, we should be able to judge how far we have progressed, and whether there have been other changes in science, technology or the socio-economic environment that now need to be considered. Most of the key recommendations would have some implications for the work of health information professionals but some have a direct impact, or might have had, if political and economic events had not overtaken the changes. The panel recommended that independent and publicly accountable bodies be formed to help regulate the privacy, availability, sourcing and accuracy of health information, as well as the access that should be granted to certain users of that information from patient records. These are not problems with easy solutions, as the Health 2.0 Debate (December 2010) in The Economist (online edition) indicates (The Economist Debates, 2010). Nevertheless, there is still strong support for the idea that patients should have more control over the health information that belongs to them. In the UK, the White Paper published in 2010 (Department of Health, 2010a) suggests that patients should have control of their health records, that patients should be able to determine who else can access their records, and should be able to see what changes have been made to their records. Sharing of records with organizations such as support groups should be possible if that enables patients to manage their condition better. Aggregated (and anonymized) patient data should be made available in a standard format to allow accredited intermediaries to analyse this for research, for presentation of data to patients and patient groups.

Summary

Introduction

Trying to provide a brief introduction to knowledge management, as perceived and practised in the health sector, is a challenge when there are so many books and articles on knowledge management. The computer scientist, the human resources manager, the information manager, staff development and the librarian – all have their perspective on knowledge management and what it should involve. The type of organization also affects the perspective on knowledge management, as an engineering organization or projects run by agencies such as the World Bank may emphasize the know-how, and the ‘war stories’ that staff relate to help newcomers appreciate how things are done in this organization and why. Storytelling, as it is explained by management thinkers such as Stephen Denning at the World Bank (Denning, 2000), seems very far removed from knowledge transfer and getting evidence into practice in a health service organization. Storytelling – is not that all about anecdotal evidence? That is very low down in the hierarchy of evidence for health service staff, surely. But what about the way many students are taught these days – problem-based learning, around a realistic clinical scenario or story? Clinical journals may have sections for care studies, case reports, as well as reports of research trials, and clinical decision making may be fast as it depends on scripts, outline storylines that professionals remember more easily (Urquhart, 1998).

The structures and systems that information professionals design to support better information management and knowledge management for health care staff need to reflect how people learn, particularly in the workplace. A long-term problem for many health staff is that the systems they use for patient administration just serve current needs, and although it is of course important to ensure that the record systems used are accurate and the record reflects the care provided, it is often difficult to see how the information in the patient record can be used to improve practice (Urquhart et al., 2009). Clinical audit is one step forward, and Helen Seeley (in her case study in Chapter 8) explains how her role spans clinical audit and research support.

Summary

Introduction

This chapter provides an overview of the way changes in publishing (in the widest sense) and information use are affecting library and information services in the NHS and higher and further education, and points to the way the health services aimed at greater patient and client choice will affect how primary health care services (and social care services) will be organized. Library and information services are changing and will change even more, with different models of service delivery likely to emerge. In the first section, Jenny Turner and Louise Goswami present the perspective from the NHS, discussing the implications of continuing professional development for a much wider range of staff, the needs of students on placement, and the way e-resources and open access publishing will change the ways in which staff access materials. Such open access ideals often fall foul of NHS firewalls, however. The next contribution, from Neil Ford, discusses some of the changes from the higher education perspective. Assumptions that all incoming students will be Millennials and digital natives need to be tempered by the fact that many students entering degree courses in the health professions are mature students. In many ways, such mixed groups are more rewarding to teach and support, but it is not possible to make sweeping assumptions about the information and IT literacy of the student cohort. We are still collecting good evidence about the effectiveness of various models of information literacy support, but it is likely that excellent liaison with academic staff and a support programme that is suited to many different levels of skills and knowledge is likely to be more effective than the library operating on its own. As Neil Ford points out, evidence-based practice means something to health students, and if information literacy programmes are not seen to contribute to evidence-based practice then they may not seem relevant. It is also important to remember, as Sue Lacey Bryant points out, that the existing evidence that is needed to make a decision about commissioning may be hard to find. The evidence may not come already prepared, it may need to be put together from multiple sources, and that includes sources that are not published in the traditional sense of books, journals or reports. And the information on costs is more vital than ever.

Summary

Introduction

This chapter sets the scene for this second part, which focuses on roles. Later chapters discuss some case study examples of the ways in which some health library and information professionals have developed their roles in all sorts of working environments. First of all, we need to remember what is meant by role, as discussed earlier in the overview. Sociologists can help us unpick some of the assumptions we make about roles in a working environment, and why roles can be seen as a problem or an opportunity. Second, we need to think about the distinguishing features of roles – what are the expectations of this role or that role? What should some professionals be expected to be able to do, and what skills do they need in order to be able to perform in their roles? Third, what does interprofessional working really mean, and how do we learn from reflection on our own practice, and from observing others? How do our information professional colleagues and other colleagues help us develop professionally?

The Chartered Institute of Personnel Development (CIPD) points out that there is a distinction between competencies and competences, although many people do not now distinguish between the terms. Strictly speaking, competency is precisely defined as ‘the behaviours that employees must have, or must acquire, to input into a situation in order to achieve high levels of performance’ (CIPD, 2010). The focus is on the person, and behaviour and performance. The CIPD (2010) define competence in terms of a system of minimum standards or a demonstration of performance and outputs, and the focus here is on the job. Occupational standards, which are concerned with expectations of particular job roles, deal with competences. This chapter will be focusing on competencies, and some of the competency frameworks that have been developed and used to analyse and assess health information and library workers and the work they do. Some frameworks mix competencies and competences, but sometimes the purpose of the framework helps to identify whether the focus is on the individual or the job. We need to think about expertise, the definitions of professional expertise and knowledge, and how that knowledge is acquired and developed to make a professional perform well in practice. Sometimes competencies may be identified and formal courses devised (e.g. Oliver et al. (2008) describe a special course for searching for informationists devised by an interprofessional team).

Summary

Introduction

This chapter discusses the librarian's role in research and evidence-based practice. Whilst Chapter 4 describes how evidence-based practice has provided health librarians with a range of opportunities to demonstrate their skills, this chapter outlines these roles in more detail with five case studies describing roles that support research and evidencebased practice, and in some cases become actively involved in those activities.

What is research?

Research is about the discovery of new knowledge or facts. It may involve investigation or enquiry, discovering causes, understanding activities or behaviours, exploring perceptions or testing hypotheses. Robson (2002) describes research that may be carried out in a ‘real life’ context, such as a workplace, which often involves some form of evaluation. Evaluation is a term familiar to most health librarians and is defined as ‘a study with a distinctive purpose, it is not a new or different research strategy but it is often used to assess the effects or effectiveness of something (an innovation or service for example) … whilst not necessarily research, evaluation profits from the principled systematic approach that characterizes research’ (Robson, 2002, 203). The skills, techniques and methods used in research, evaluation and evidence-based practice are often the same and to an extent there is some degree of overlap between the three concepts, therefore it makes sense, particularly when talking about librarians’ roles, that the three are considered together.

Supporting research and evidence-based practice

As noted and described in Chapter 6, librarians play an important role in supporting other people's research and evaluation activities. The National Institute for Health Research has produced a flowchart describing a ten-stage research process (www.rdinfo.org.uk/flowchart/Flowchart.html) that clearly states where libraries and librarians have a role to play. This includes a key role in the second stage of research – the literature review, by providing advice, training and guidance on literature searching and reviewing or conducting searches on behalf of researchers. In health service research this may well be to researchers based in academic institutions or to clinicians who conduct research within the health service.

Summary

Books

Typical questions

Summary

This set of chapters on digital collections fills an important gap in the professional literature of the memory institutions: libraries, museums, and archives. While much has been written of late on the evolution of digital scholarship, most analyses are written by and for scholars. These chapters are written by librarians, archivists and scholars engaged in building, assembling and digitizing content for a range of audiences, largely in the humanities. As noted in the acknowledgements, the book emerged from an expert seminar in e-research. The result is a coherent arrangement of chapters from a group of authors collaborating toward a common goal of identifying metrics for digital collections.

They survey developments, concerns, best practices and criteria for evaluation in a wide range of projects across the United Kingdom, Australia and New Zealand – where these authors currently are based – with reference to projects in the United States and elsewhere. The comparison of efforts in libraries, museums and archives, which in turn serve universities, schools, theatres and other environments, offers a rich set of case studies. A number of policy issues cut across these environments, most notably intellectual property rights and provenance.

Information professionals, managers and students alike will find much of value in this volume. The current environment of accountability is particularly problematic for the humanities. The ‘impact’ or value of collections may not be evident for years, decades, or even centuries after the origin of the materials, yet funders demand immediate economic indicators. These chapters take a balanced approach, acknowledging the trade-off in short and long term assessment of value, and to whom.

In all fields, the availability of scholarly content in digital form makes possible new research questions, methods and uses. The humanities especially have benefited from the ability to digitize historic documents, to mine large corpuses of texts, audio and images, and to assemble widely dispersed cultural objects into common repositories for comparison and analysis. Yet digitization is a means for scholarship and learning, not an end in itself. Careful assessments are required of trade-offs between usability and honesty to original form, between image quality, speed of access and cost, and between assorted other project-specific factors.

Summary

Introduction

Impact and value of digitized collections are concepts that are both being brought to real life through users. Any metrics and criteria that would try to capture impact and value have to factor in first how individual users (or user communities) benefit from the digitized resources in question.

Thus, one specific difficulty in measuring impact and value is the subjective and quickly changing user-related component of the valorization process. How exactly could we find out whether a digital resource had an impact on users? What value propositions have resource creators intended to convey to their target audiences? How well did these target audiences understand the message – is the value they see in the resource and surrounding services identical to what its producers had in mind? This chapter presents a description of user evaluation methodologies, and discusses how user considerations can be factored into the digitization process. It presents a case study describing user involvement in projects on digitization of audiovisual materials.

The user paradox: users are valuable in digitization policies but not sufficiently involved

As the volume of digitized resources grows, so does the number of studies and publications on user studies within the digital library domain, although these have been limited in scope, as noted recently by Michael Khoo and colleagues: ‘In the case of digital library researchers, the focus of research is often on technical issues (e.g., information retrieval methods, software architecture, etc.) rather than on user-centered issues’ (Khoo, Buchanan and Cunningham, 2009).

In fact, we are currently witnessing a paradox: major institutions from the cultural heritage sector clearly emphasize the place of user evaluation and feedback in digitizationrelated policies. But in reality, decisions about aspects of digitization that impact users are frequently taken without direct user involvement.

For example, the National Library of Australia Collection Digitisation Policy (National Library of Australia, 2008) states that: ‘The Library's digitisation activities take account of user evaluation and feedback. Users are encouraged to provide feedback and make suggestions through the Digital Collections user feedback form or other ways.’

Summary

Introduction

For almost two decades the UK has enjoyed significant amounts of spending on the digitization of scholarly and cultural material. It has been estimated that, since the mid- 1990s, £130 million has been spent on the creation of digital content in the UK (JISC, 2005). However, it is now evident that we are experiencing a time of unprecedented challenges and changes within the UK. This is the case with both the information ecosystem that we now inhabit and the new economic climate that exists. This convergence of circumstances has led to concepts such as impact and value reestablishing themselves as important factors for academic institutions and the resources they develop and for the bodies and organizations that fund this important work.

We should avoid the assumption that the desire to better understand the impact and value of digital resources and the uses to which these resources are being put is something new, and the result of this ‘perfect storm’ of circumstances. Most funding bodies have long expressed the need for the projects they fund to address issues of impact. As an example, the National Science Foundation in the USA has been asking its projects to consider the impact of its work since the early 1990s. There have also been a number of studies and guides that have attempted to address the needs of projects and resources in assessing the usage and impact of digital resources, for example: user analysis (Warwick et al., 2006; Harley et al., 2006); libraries and the impact of digital resources (Spiro and Segal, 2007); and understanding your audience (Quirk et al., 2009).The result of this growing body of research is an increased understanding of the different impacts that digital resources are having within the scholarly community, and the potential benefits they could bring to, and value they could have for, this community.

However, while it is undoubtedly a cliché, there is some truth in the argument that until relatively recently digital resources have often been created with a ‘build it and they will come’ mentality (Warwick et al., 2008).

Summary

Introduction

The purpose of this chapter is to present an overview of digitization activities and issues in the archives domain. The vast new digital collections that are being developed provide striking examples of impact both internally and externally, that is, on the workflows and functions of archival institutions and on global communities of users.

Archival institutions keep records – but only those records that are considered to be worth preserving in perpetuity. Archival records are therefore those that have enduring value, as evidence for accountability as well as perhaps also having intrinsic informational value not simply today, but also far into the future. The ability to make digital copies of archives available via the internet has had far-reaching influences on archival services, and on users’ perceptions and experiences of archival records. Traditionally, archival institutions have been the exclusive preserve of specialist researchers, but changing societal norms and information needs, particularly relating to family history research, have been instrumental in changing that focus. Digitization has played a key role, being both a consequence of, and motivator for, those changing requirements.

This chapter focuses on projects to make paper records available in digital form. It will not cover current activities to develop repositories and strategies to manage borndigital information. Challenges in that domain are quite distinct; particularly important are the activities that take place when information is created and captured into recordkeeping systems. Significant areas of concern centre around the extent to which everyone has to be aware of record-keeping responsibilities. Attempting to cover both born-digital and digitized information within a single chapter would not do justice to either.

The structure of the chapter is as follows. First, the drivers for digitization in archives are identified and discussed, followed by consideration of the issues that arise. The impact of digitization on traditional archival functions and services and the emergence of new organizational forms are described. The chapter concludes by summarizing the impact of the ability to digitize on archival services.

Drivers for digitization

There are three main influences on digitization activities in archives: the changing usage and user profile of archives; reformatting as a preservation strategy; and the ability to crowdsource and harness ‘user power’.

Summary

Introduction

Imagine walking into one of Britain's great cathedrals. As you take in the architectural, cultural and religious ambience, your mobile device automatically engages with content on your behalf.

So, just when you ask for it, the local tour is available in your own language. But there is much more: images and information on the stained glass too high to view, videos of famous ceremonies, 3D walk-throughs showing how the cathedral may have looked in previous centuries, full text of historic and literary references, a list of people buried, baptized or married, choral works performed, oral histories of local residents, news reports through the centuries; this list of opportunities could and will grow even longer.

This is the inherent promise of digitized resources and yet we have not achieved this goal with many of our digital collections. Technology exists to drive forward a vision of intelligent environments that supply the right information to the right person at the right time. Paradoxically, what is missing is the depth of digitized content to make such technical developments more significant than mere mobile playthings. The treasure house of content has to be digitized much more comprehensively.

Much has been achieved, but there are opportunities for much more impact, benefit and a greater return on the investment made in creating digital collections if we continue to invest in the knowledge economy by digitizing our wealth of information resources.

This chapter will consider the opportunities and impacts that digitized resources have made for learning, teaching, research and society. The focus for this chapter comes from the significant impact and value in the UK discovered during the JISC-funded research project, Inspiring Research, Inspiring Scholarship (Tanner and Deegan, 2011). It will conclude with the suggestion that the impacts of digitized resources are being negated by the very modes of measurement and evaluation currently in place, and will posit fresh areas for investigation.

Overview of opportunities, benefits and impacts from digitized Resources

What the Bodleian Library is doing now, in digitising large portions of our vast collections, is like the human genome project. Thousands of people can evaluate and use creatively the digital resources to discover new ideas and make innovations.

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6023 results in Facet Publishing

1 - The changing context of health for library and information professionals

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7 - The librarian who analyses information and manages knowledge

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2 - Changes in information generation and use

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5 - Skills, competencies and knowledge

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Contents

List of contributors

8 - The librarian within research and evidence-based practice

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Frontmatter

Part 1 - Digital transformations in libraries, museums and archives

The contributors

Section 2 - General Sources

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Part 2 - Understanding and measuring the use, impact and value of digital collections

Miscellaneous Endmatter

Foreword

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6 - User needs in digitization

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Part 4 - Hobbies, Leisure and Sport

5 - A strategic approach to the understanding and evaluation of impact

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Part 1 - General Sources

4 - The digital archive

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8 - The value and impact of digitized resources for learning, teaching, research and enjoyment

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