Developing Integrated Knowledge Services for NHS Scotland:
Managing Continuity and Transition within a New Collaborative Dynamic
Progress Report for Steering Group Meeting, 13 November 2003
Covering the period 1 September 2002- 31 October 2003
Contents
1. Summary
P1
2. Developing an integrated strategy for development of NHS Scotland Knowledge
Services
2.1 National strategy
2.2 Development of NHS Knowledge Services at unified NHS Board level
2.3 Communication regarding strategic development
2.4 Quality assurance
P1
3. User needs analysis
P6
4. Development of the NHS Scotland e-Library
P7
5. Cross-boundary partnerships
P10
6. Information skills training
P12
7. Promotion and outreach
P13
8. Development of the NHS Librarian role
P15
9. Conclusion
P16
10. References
P17
Developing Integrated Knowledge Services for NHS Scotland:
Managing Continuity and Transition within a New Collaborative Dynamic
P1
P4
P5
P6
1
Developing Integrated Knowledge Services for NHS Scotland:
Managing Continuity and Transition within a New Collaborative Dynamic
Progress Report for Steering Group Meeting, 13 November 2003
Covering the period 1 September 2002- 31 October 2003
1. Summary
1.1 The past thirteen months have marked a new phase in development of Knowledge Services
for NHS Scotland. Like most new beginnings, this period has been characterised by uncertainty as
well as anticipation, and by a sense of loss of familiar ways of working, as well as the opening up
of new opportunities.
1.2 The following paper outlines progress in the major development areas identified for NHS
Knowledge Services in the strategy documents produced this year 1,2,3 :






Integrated strategic planning at national and local levels
Analysis of user needs
Development of the NHS Scotland e-Library as a vehicle for integrated service development
and a core component of a modernised knowledge infrastructure.
Improved sharing of knowledge across disciplinary, health board and sectoral boundaries,
including support for the emerging new models of healthcare delivery (e.g., Managed Clinical
Networks, Community Health Partnerships)
Development of information skills training, promotion and outreach, with a focus on the needs
of remote and rural areas, primary care and non-clinical staff groups.
Augmentation of the importance of the librarian role in supporting the new system.
1.3 While development of Knowledge Services will need continually to adapt to ongoing changes
within the wider NHS context, the experiences of the past year have, hopefully, clarified the
framework for future development in the necessary spirit of shared ownership and investment.
2. Developing an integrated strategy for development of NHS Scotland Knowledge Services
2.1 National strategy
2.1.1 The core principle for strategic planning has been the need for coordination and
modernisation of Knowledge Services, as a necessary response to persistent evidence of existing
fragmented, inequitable and inaccessible delivery of Knowledge Services throughout NHS
Scotland 4,5.
2.1.2 In the absence of any prior nation-wide strategic approach, there has been a strong emphasis
on defining vision and identity for NHS Scotland Knowledge Services. The discussion paper
The nature of future strategy for management of the knowledge base of healthcare for NHS
Scotland 2003-2006 1 was produced on the basis of pilot work on strategic development of
Knowledge Services in NHS Greater Glasgow and NHS Grampian, together with reference to
issues in the wider NHS library service network and over-arching NHS policy. This paper set out
for the first time the vision of a new infrastructure for Knowledge Services, based primarily on
the NHS Scotland e-Library as a vehicle for coordinated and equitable service delivery, and
mediated through the skills and expertise of information practitioners and managers.
Developing Integrated Knowledge Services for NHS Scotland:
Managing Continuity and Transition within a New Collaborative Dynamic
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2.1.3 Guidelines and a template 6,7 have been produced for development of local strategies at
unified NHS Board level, reflecting underpinning national principles and priorities and
contextualised in the light of local circumstances.
2.1.4 The following consultative groups have been established at librarian and senior management
level with responsibility for input to, and dissemination of, these strategic themes:

The Steering Group for Development of NHS Scotland Knowledge Services,
comprising one senior manager nominated by the Chief Executive of each NHS Board,
with responsibility for supporting, and advising on, national and local Knowledge Service
developments.

The Communicators Group, comprising one librarian nominated by their peers in each
NHS Board, tasked with acting as the communications link between local and national
developments, and playing a lead role in development of local strategy.
Both groups approved the broad strategic principles identified in the original strategy paper 1
and accepted responsibility for furthering these themes within local services.
2.1.5 The Senior Management Team and Board of NHS Education for Scotland subsequently
developed and refined the integrated national/local strategic approach as originally defined. NHS
Education has now formally endorsed the vision of NHS Knowledge Services as:



Transformed and modernised by application of technology
Capable of delivering knowledge to point of need on an equitable basis to all staff groups
and all geographic areas.
Facilitated by skilled information practitioners and managers linking the technology to
user needs and information-seeking behaviour.
- all being essential for delivery of the overall aim of a state of the art national Knowledge Service
for NHS Scotland, empowering the NHS workforce to deliver the highest possible standard of
care throughout all stage of the patient journey.
2.1.6 The NHS Education strategy describes Knowledge Service management in its fullest sense.
In addition to development of the NHS Scotland e-Library as a core part of the knowledge
infrastructure, this concept includes the wider dimensions of Knowledge Service delivery which
rely on complementary resources and formats and on the expertise of information practitioners
and managers.
2.1.7 Key themes for strategic development have been defined as:

Consolidation of e-Library content including journals, books, databases, free websites, etc to
ensure provision of knowledge appropriate to the needs of the full spectrum of NHS staff.

Development and implementation of technical standards and solutions that will make possible
integration of local and national knowledge sources, and mobilisation of knowledge to
integrate with patient records and care pathways.

Application of knowledge management principles to facilitate:
 Development of online learning communities
Developing Integrated Knowledge Services for NHS Scotland:
Managing Continuity and Transition within a New Collaborative Dynamic
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

Sharing of knowledge across disciplines and sectoral boundaries, to match the
knowledge needs of new healthcare models such as Managed Clinical Networks and
Community Health Partnerships
Creation of tailored, proactive Knowledge Services that “push” relevant knowledge
personalised to individual need out to users.

Provision of national and local information skills training and outreach programmes to
meet the needs of staff groups currently under-served in this respect – for example, in remote
and rural areas and primary care.

Intensified training of the librarian workforce to enable fulfilment of the new roles of
educators, facilitators, managers and expert searchers, as required by the new service.

Production, under the auspices of NHS Quality Improvement Scotland, of quality assurance
mechanisms for NHS Scotland Knowledge Services.
2.1.8 NHS Education has committed to coordinated service development at local, regional and
national levels, including continuing support for development of local strategies and in particular
to a project-based approach in the Northern Region. This project will aim to define relative roles
and responsibilities of the various partners and sectors involved in delivery of Knowledge
Services which are at once responsive to local need and which reflect regional and national
principles and priorities. The intention is to define a model transferable in essentials to other
areas of the country, which provide convincing evidence as a basis for production of Scottish
Executive guidance on development of Knowledge Services.
2.2 Development of NHS Knowledge Services at unified NHS Board level
2.2.1 It was apparent from the first that this integrated local/national approach to service delivery
entailed a change of considerable magnitude for existing services. Early symptoms of change
have, understandably, been a fear of loss of local autonomy, and difficulty in distinguishing the
offer of supportive guidance from prescriptive direction.
2.2.2 As can be seen from the accompanying reports from Communicators, an encouraging
majority of services have, nonetheless, risen to the challenge of coordinated strategic
development based on sharing of resources and expertise, with the associated transition in
librarian role to strategic manager, “knowledge navigator”, expert searcher and educator rather
than the traditional administrator of print collections. It has been especially encouraging to see the
innovative approaches adopted to project planning and establishing user need.
2.2.3 The universal dilemma of managing service development within finite resources, entailing
the ever-difficult task of defining priorities to match budgetary scope, is much in evidence. As
was only to be expected, a certain amount of conflict has surfaced as these changes impact upon
existing networks and familiar ways of working.
2.2.4 Key lessons learned to date would seem to be:

The need for clear definition of roles and responsibilities of all parties enlisted in the
partnership approach. Some overlap and ambiguity is probably inevitable in the early stages
of the change process.

Ownership, control and concomitant acceptance of management responsibility are obviously
essential components of participation at all levels.
Developing Integrated Knowledge Services for NHS Scotland:
Managing Continuity and Transition within a New Collaborative Dynamic
4

This integrated approach is fraught with inherent clashes of interest, including tensions
between local and national remits, and between operational and strategic issues. A desire for
an authoritative national directive to “enforce” change for the better coexists with a concern
to protect familiar, autonomous ways of working and to decelerate the pace of change.

The need for identifiable, accepted responsibility for development of Knowledge Services at
NHS senior management and Executive levels, particularly in areas where services are
predominantly contracted out to Higher Education.
2.2.5 Strategic planning for Special NHS Boards has proved particularly challenging, due to the
specialised context, frequently characterised by organisationaal complexity and recent extensive
restructuring. A meeting of Special NHS Board librarians in early October 2003 helped to identify
some common developmental themes, including the challenge of managing internally-facing
services alongside a national, externally- facing remit, and potential roles as “Centres of
Excellence” in their specialist fields.
2.3 Communication regarding strategic development
2.3.1 Effective communication with library service providers, users and stakeholders is clearly
essential during this period of change. To date, communication between the Knowledge Services
Group within NHS Education and the wider health service has primarily been via librarians and
senior managers holding responsibility for library services.
2.3.2 Mechanisms of communication have included:

The Communicator role: This role is key to achieving coordinated development at local and
national levels and to developing an ethos of shared ownership and involvement. Meetings of
Communicators with the Library Service Development Coordinator are currently held on a
monthly basis. The formats have varied from business meetings to presentations and group
work based on themes.

Newsletter: During 2003, there have been two issues of Chrysalis, the newsletter highlighting
key developments relating to NHS Scotland Knowledge Services. A third issue is in
preparation for December 2003.

Discussion list. Lis-nhsseducation has been created for dissemination of information among
library and information workers and educators with an interest in development of NHS
Scotland Knowledge Services. Membership currently stands at 150 individuals.

Four Open Forums were held during April 2003 to introduce librarians and managers to the
strategic approach and key development themes.

Visits by the Library Service Coordinator to the majority of services, meeting with librarians,
Steering Group members and other stakeholders, have provided opportunities to discuss
developments from all perspectives, in order to support production of local strategies. In
several cases, these visits have been followed up by short reports to librarians and Steering
Group representatives on key service issues. Visits and interviews regarding e-Library
training with service representatives in each NHS Board, together with visits by the Managed
Knowledge Networks Project Manager to West of Scotland Library Services to discuss crosssectoral working have provided further occasion for exchange of views and concerns.
Developing Integrated Knowledge Services for NHS Scotland:
Managing Continuity and Transition within a New Collaborative Dynamic
5

Short Life Working Groups established with a focus on: 1.) e-Library tender; 2.) Librarian
job descriptions and Agenda for Change; 3.) e-Library promotion and outreach; 4.) Feasibility
study for a unified library management system.
2.3.3 An overview of communication during the past year suggests that, with the notable
exception of the Short Life Working Groups, the mechanisms available for greater community
involvement are not currently being used to their full potential. Open discussion of this concern at
the Communicators’ Group has suggested new approaches to communication on both sides,
including: greater definition and support for the Communicator role; alternation of national
Communicators’ meetings with regional, cross-Board meetings to enable discussion of proposals
and identification of local concerns requiring debate at national meetings; and a more structured
approach to management of national meetings.
2.3.4 Overall, an important crux in development has been the challenge of creating new
communication channels to match the current transition from a system of largely independent
library units to a coordinated and interdependent network of NHS services. We can, however, be
fairly confident that the necessary mechanisms have been set in place and that there is a basic
commitment on all sides to learn and adjust as required to use these channels effectively.
2.4 Quality assurance
2.4.1 The need for a quality assurance framework to support the principle of equitable provision
of knowledge services is widely recognised. Preliminary discussion with the Communicators’
Group has highlighted the preference for a continuous quality improvement approach that
supports direct ownership of development plans by service providers, rather than a prescriptive
standards-based approach. NHS Quality Improvement Scotland has indicated its support in
principle for development of quality assurance processes keyed to the specific needs of NHS
Knowledge Services, and it is planned that the Northern Region Project will facilitate detailed
definition of such a system.
2.4.2 The Knowledge Services Group has overseen participation by NHS Scotland Knowledge
Services in the annual collation of activity and financial statistics carried out on a UK-wide basis
by the NHS Library and Knowledge Services Development Network. These statistics are
currently being analysed in detail and have already helped to clarify the national picture of service
provision.
3. User needs analysis
3.1 Analysis of user need is clearly an essential prerequisite for evidence-based development of
Knowledge Services and the NHS Scotland e-Library. Two user needs analysis studies have been
conducted in the past year – one focusing on representatives of different NHS staff groups; the
other on the needs of new interdisciplinary models of care, including Managed Clinical Networks
and emerging primary care configurations 8,9 . Key findings are:

Remote access to the knowledge base is now considered essential for all NHS staff.

Integration of knowledge sources and linking with patient record systems is required to
simplify access and ensure application of knowledge to delivery of patient care.

Services tailored to the needs of individuals and staff groups are required to address the
problem of information overload.
Developing Integrated Knowledge Services for NHS Scotland:
Managing Continuity and Transition within a New Collaborative Dynamic
6

A proactive approach to service provision, using “push” mechanisms to alert users to new
information in their field of interest is an important next stage in service development

Gaps are evident in existing services, with regard to evaluated evidence, the needs of nonclinical staff, and the new staff roles created by modernisation of the NHS.

New, cross-boundary health service models and emerging new roles for NHS staff create a
need for a knowledge management culture that facilitates sharing of knowledge

Users recognise that the role of the librarian needs to change from administrator of print
repositories to educator, knowledge navigator and expert searcher.

Cultural issues and a widespread deficiency in information skills training at all levels
currently constitute barriers to effective use of the knowledge base.
3.2 These findings give us a clear set of basic recommendations on which to base future
development of the Knowledge Service infrastructure for NHS Scotland.
4. Development of the NHS Scotland e-Library
4.1 The NHS Scotland e-Library is a crucial component of this new knowledge infrastructure. By
its very nature, it has a unique potential to serve as a vehicle for integration of services, providing
access to knowledge on an equitable basis at point of need to all NHS staff, regardless of
discipline, sector or geographic location.
4.2 e-Library development during the past year has focused, firstly, on consolidation and
expansion of content; secondly on development of architecture and functionality.
4.3 e-Library content
4.3.1 The decision was taken in late 2002 to extend e-Library content on a pilot basis, expanding
its original narrow biomedical focus to reflect NHS Education’s new multidisciplinary remit for
education and lifelong learning for all NHS staff groups. The redesigned and expanded e-Library
was launched on 20th January 2003 with some 4000 fulltext electronic journals, approximately
200 electronic textbooks, 20 subscription databases and 1500 free health information websites,
covering Nursing and Midwifery, Health Improvement, Allied Health Professions, Management,
Estates and Facilities, Science and Technology, Personal Development and Lifelong Learning as
well as an extended range of biomedical resources.
4.3.2 Evaluation of e-Library usage to date shows a continuing upwards trend in all staff groups
and NHS Boards (see figures 1 and 2), although the low uptake within primary care and among
non-clinical staff would benefit from attention. Qualitative feedback from users, scenarios
demonstrating the real-life impact of e-Library services, and cost-effectiveness calculations have
been recorded in the draft business case for development of the e-Library 10 and in the strategic
overview of development of NHS Knowledge Services 2 presented to the Board of NHS
Education. The accumulated evidence testifies clearly to the benefits to patient care of this new
knowledge service and has been crucial in securing the ongoing support of NHS Education for the
development programme.
Developing Integrated Knowledge Services for NHS Scotland:
Managing Continuity and Transition within a New Collaborative Dynamic
7
Level of Access
Figure 1. e-Library Usage Jan-Sept 2003: all staff groups
45000
40000
35000
30000
25000
20000
15000
10000
5000
0
Jan
Feb
Mar
Apr
May Jun
Jul
Aug Sept
Oct
Nov
Dec
2003
Developing Integrated Knowledge Services for NHS Scotland:
Managing Continuity and Transition within a New Collaborative Dynamic
8
Figure 2: Usage by NHS Board - Sessions per 100 staff
60
Sessions
50
40
30
20
10
0
Western Isles
Tayside
State Hospital
Shetland
Orkney
NHS-24
Lothian
Lanarkshire
Highland
Greater Glasgow
Grampian
Golden Jubilee
Hospital
Forth Valley
Fife
Dumfries & Galloway
Common Services
Agency
Borders
Ayrshire & Arran
Argyll & Clyde
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Health Board
NB: Total staff figures not available for Health Scotland and NHS QIS, hence these Boards are not shown in Figure 2.
Developing Integrated Knowledge Services for NHS Scotland:
Managing Continuity and Transition within a New Collaborative Dynamic
9
4.3.3 During September and October 2003, NHS Education has been directing attention to
ongoing e-Library development from January 2004 onwards. For the coming year, we have had to
digest, within static budgetary parameters, the rising costs of current subscriptions, new costs for
formerly “free” e-Library resources, and expansion needs of the e-Library and the wider
Knowledge Services development programme.
4.3.4 Through negotiation, we have been able to meet these challenges, and not only to maintain
almost all existing e-Library content, but indeed to extend coverage and develop partnerships, as
well securing the necessary funds for further technical development, and for essential projects in
the wider Knowledge Services context. It is especially gratifying that the forthcoming e-Library
subscriptions incorporate free access to selected resources on a one year pilot basis for public
libraries, Higher Education and the National Library of Scotland. These initiatives should help to
demonstrate the potential of the e-Library in facilitating seamless access to health information
across sectoral boundaries, and to lay foundations for exploring the potential for future
collaborative purchasing.
4.3.5 In the majority of cases, suppliers have demonstrated their confidence and support by
extending access to e-Library content at trial rates until the end of March 2005. The business case
for full-scale development at substantive costs from April 2005 onwards is now in process of
being formulated. NHS Education has affirmed its commitment to the e-Library service as a
core element of its wider remit for education and lifelong learning for all NHS staff. This new
development phase will provide the opportunity for librarians and users to consolidate the
achievements of the past year and to incorporate the e-Library as a familiar and indispensable
tool in their routine working practice.
4.4 Technical development of the NHS Scotland e-Library
4.4.1 A usability study conducted in April-May 2003 highlighted key areas for development of eLibrary interface and architecture to facilitate easier access to the knowledge base.
4.4.2 The technical development team, appointed during the first quarter of 2003, has been tasked
with securing the future of the e-Library, independently of funding considerations with regard to
subscription content, through application of the following interrelated principles:
 standards-based infrastructure
 strategic partnerships
 a distributive model of knowledge access
 user interaction and ownership
4.4.3 The specification document A Standards-Based Knowledge Infrastructure for the NHS
Scotland e-Library 11 describes standards for metadata structures, controlled vocabularies and web
services adopted by the e-Library . It emphasises the importance of the standards-based approach
in order to enable knowledge sharing to cater for the full spectrum of health information need,
offering guidance to other knowledge service providers regarding utilisation of interoperability
technologies to enable cross-searching and interfacing with the e-Library within the context of a
distributive information environment.
4.4.4 The current phase of e-Library development includes a focus on the following functions and
interactive features, due for usability- and system-testing during the next 3-4 months:

Basic and advanced search and browse facilities, relying to a large extent on utilisation and
mapping of controlled vocabularies.
Developing Integrated Knowledge Services for NHS Scotland:
Managing Continuity and Transition within a New Collaborative Dynamic
10

Alerting services, supporting users in keeping up to date with new knowledge in their field of
interest added to the e-Library or to its component databases.

Personalisation of the user landscape, enabling the user to create favourites lists; alerting
profile; homepage preferences; and to restrict retrieval to resources key to their particular staff
group.

Interactive topic areas which enable users to submit their own content, establish and use
discussion forums, bulletin boards, etc.

Content submission and evaluation processes which aim to involve librarians and users in
contributing directly to e-Library resources.

Development of Subject Portals, initially in the priority areas of Cancer, Coronary Heart
Disease and Mental Health as part of the Managed Knowledge Networks project (see below).
These portals are fully embedded in the e-Library infrastructure, aiming to facilitate provision
of high quality health information across sectoral boundaries to healthcare staff and
consumers. This area of development calls for a particular emphasis on ownership by the
target audience, to be achieved in part through promotion of the interactive features described
above.
4.4.5 NHS Education has made available, from January 2003, an Internet-based document
requesting system linked with the e-Library, offering customisation to meet the needs of
individual services. This system has the potential to increase efficiency in interlibrary loans
management and record keeping. It enables users to place requests online directly to their local
NHS library service, reducing significantly the manual administration currently required of many
professional NHS librarians. During 2003, three new NHS Boards have implemented this
software, and the Knowledge Services Group is currently working with two further Boards to
tailor the service to their individual requirements. In all cases, the system has served as a tool to
engage library services in addressing some of the practical challenges associated with delivery of
an equitable, coordinated Board-wide service.
4.4.6 Online password registration was introduced in January, enabling access to the full range of
e-Library subscription content via a single username and password. This password system has
been further refined to enable instantaneous receipt of passwords from within NHSNet and to
afford access to a majority of local electronic journals in addition to national content. This
registration system now forms the basis of the personalisation and profiling features outlined
above.
4.4.7 A series of targets for cross-searching with the e-Library has been identified. Technical
implementation of access to BIOME and Health Scotland has already been achieved within the
e-Library re-build. New targets include ZETOC/Ingenta – a combination which enables searching
of journal tables of contents linked with fulltext journals; PubMed as the interface to a range of
free open access journals, and various projects listed in section 5 below within the context of
“Cross-boundary partnerships”.
5. Cross-boundary partnerships
5.1 A commitment to equitable access to health information across disciplinary, health board and
sectoral boundaries is fundamental to the NHS Education strategy for development of
Knowledge Services for NHS Scotland. Key developments in cross-boundary working during
the past year are outlined below.
Developing Integrated Knowledge Services for NHS Scotland:
11
Managing Continuity and Transition within a New Collaborative Dynamic
5.2 The distributive, standards-based approach and innovative features being developed by the eLibrary are designed to promote partnership in knowledge management within the NHS and
across sectors. The Knowledge Services Group has already reached agreement with BIOME (a
Higher Education Biomedical Subject Gateway) and Health Scotland to enable the redesigned eLibrary to incorporate cross-searching with BIOME’s database of 23,000 evaluated health
information websites and with the Health Scotland database of voluntary organisations.
5.3 We have from the first recognised the importance of effective communication with NHS 24
and have met regularly with their representatives throughout the year. Both parties recognise the
importance of managerial cooperation and application of appropriate technologies to manage the
interface between publicly- and professionally- oriented online health information to best effect.
5.4 A proposal from the Knowledge Services Group has been accepted in principle by SHOW
(Scottish Health on the Web) for exploration of cross-searching technology. Initial
communication has now taken place with the Scottish Executive Health Department Information
Management team with regard to cross-searching ther online databases of government reports and
policy documents and a first meeting of technical teams has been organised. We are also
following up interest in collaborative working expressed by the Scottish Centre for Infection and
Environmental Health and by the English National electronic Library for Health.
5.5 The Knowledge Services Group, together with the Stroke Therapy Evaluation Project based in
Glasgow Royal Infirmary has been successful in obtaining New Opportunities Funding to
develop an online compendium of best evidence in stroke therapy, to be fully interoperable with
the NHS Scotland e-Library. It is anticipated that this project will commence in early 2004.
5.6 We are working closely with Voluntary Health Scotland on defining a picture of health
information provision in the voluntary sector. We are also offering support for structure and
indexing of their new online database of voluntary health organisations, with a view to optimising
cross-searching with the e-Library and other relevant knowledge sources. A forthcoming survey
by Voluntary Health Scotland will raise awareness of e-Library entitlements among those
voluntary organisations which receive part-funding from the NHS and will enhance our
understanding of information resources, standards and services and the training needs within this
sector.
5.7 Collaboration with the Centre for Change and Innovation has led to agreement to make two elearning collections of management toolkits and techniques available via the e-Library from
December 2003. There will be extensive two-way linkage between e-Library resources and the
new Centre for Change and Innovation website, which will rely on the e-Library authentication
system and online registration process.
5.8 The Managed Knowledge Networks project 12 within the Knowledge Services Group has
completed a multi-sectoral survey of health information provision in the priority areas of cancer,
coronary heart disease and mental health in the West of Scotland. The Project Manager is
currently mapping service provision, with a view to identifying gaps, and opportunities for more
equitable access to health information across sectoral and geographic boundaries. As such, the
project includes a strong focus on the knowledge needs of Managed Clinical Networks,
Community Health Partnerships and other emerging interdisciplinary models of care.
Development of subject portals within the e-Library will prove to be a key mechanism to meet
cross-boundary knowledge needs.
Developing Integrated Knowledge Services for NHS Scotland:
Managing Continuity and Transition within a New Collaborative Dynamic
12
5.9 Agreement has been reached with EBSCO Information Services for Scotland-wide access via
the e-Library to the EBSCO gateway for local electronic journal subscriptions. This arrangement
will facilitate integrated access by individual NHS Boards to their local resources in parallel with
national content.
5.10 As another aspect of integrated service development, a feasibility study analysing in some
detail the potential benefits and costs associated with introduction of a unified library catalogue
and circulation system linked with the e-Library is currently underway. Such systems are
relatively common the NHS elsewhere in the UK and play an important role in service
coordination by facilitating resource sharing and reducing duplication of effort. Although only at
the exploratory stage at present, this project has already been valuable in highlighting the absence
of such basic service management tools in several NHS Boards, the extensive variation in current
practice, together with practical concerns surrounding such a resource-sharing model. It is hoped
to plan to use this data to define the costs and benefits of various potential models with a view to
incorporation in the business case for long term development of the NHS Scotland e-Library.
5.11 With regard to interaction with the Higher Education sector, the Library Service
Development Coordinator is a member of the UK-wide NHS/HE Forum and the Content
Purchasing Subgroup. The user needs analysis specification created for NHS Scotland Knowledge
Services has formed the basis of a wider cross-sectoral needs analysis proposal for the NHS/HE
Forum. This body is now seeking Department of Health funding for this proposal, together with a
series of related projects, including analysis of funding models and training needs at the NHS/HE
interface.
5.12 Closer to home, within Scotland, Higher Education has of course always been recognised as
a key player in provision of health information. Differences in service focus, identity, scale and
maturity in the NHS and Higher Education sectors, together with a sense of uncertainty on both
sides regarding the impact of the e-Library and an NHS-led strategy on traditional financial
contribution by the NHS to Higher Education Library Services, create difficulties in determining
how to develop partnerships in practical terms. The project approach planned for the Northern
NHS Region should help to clarify the issue of relative roles and responsibilities in provision of
Knowledge Services to the NHS.
5.13 Within the negotiations for e-Library subscriptions for 2004/5 we have successfully
incorporated free access to selected resources on a one year pilot basis for public libraries,
Higher Education and the National Library of Scotland. This opportunity should enable us to
explore further the potential for a holistic approach to health information and for collaborative
purchasing as a means to that end.
5.14 Despite some reservations relating to loss of autonomy, discussions on local NHS library
strategies are beginning to incorporate the principle of cross-sectoral and cross-disciplinary
working, particularly with regard to outreach and information skills training.
5.15 It hoped that the above initiatives are helping to demonstrate the potential of the e-Library
and the wider strategy for Knowledge Services in facilitating seamless access to health
information across sectoral boundaries, laying the foundations for more extensive future
collaboration.
Developing Integrated Knowledge Services for NHS Scotland:
Managing Continuity and Transition within a New Collaborative Dynamic
13
6. Information skills training
6.1 Improved information skills competency is a key element within the vision of a modernised
health service supported by an high quality knowledge infrastructure. It is, accordingly, a core
development area within the NHS Education strategy for Knowledge Services.
6.2 An overview of information skills training by NHS Library Services has been conducted,
resulting in the following recommendations and conclusions 13 :

The training need for the 135,000+ NHS staff involved is enormous, and far from being met
anywhere, directly impacting on e-Library usage and acceptance

Training undertaken by librarians to date ranges from some scheduled sessions, to ad hoc, to
complete absence. There appear to be no Board-wide or co-ordinated training programmes only patchy local initiatives, which, significantly, are generally over-subscribed.

Training is generally conducted at a basic level, comprising general overview of the e-Library
or of generic resources such as the OVID databases or the Cochrane Library. There is little
evidence of advanced or specialist training for defined subject areas or audiences, or
embedding of training within the context of evidence based practice.
Primary Care, remote and rural areas and non-clinical staff groups are especially poorly
served with regard to information skills training.


Training efforts are being needlessly duplicated with little regard for recognition and
dissemination of best practice.

Librarians in many areas are aware of the need to raise the profile of the e-Library and library
services in general, but feel they lacked the resources, time and contacts to do this
themselves. Despite this acknowledgement, there is a resistance in several areas to provision
of training by external bodies or by non-librarians.
The conclusion is that information skills training has not been afforded sufficient consideration at
local or national level in the early stages of the e-Library project. It requires a much higher
priority, with appropriate allocation of staff and resources. Specific recommendations from this
overview include the following:

The roles of NHS Education and NHS Librarians in provision of information skills training
need to be more clearly defined

Overall training objectives need to be established, based upon a formal training needs analysis

Information skills training needs to take root beyond the library domain to involve partners
such as Information Technology, Training and Organisational Development and clinicians
themselves.

The success of the Knowledge Services Group in creating and collecting training resources
should continue to be expanded.

Partnerships for training should be sought with other organisations, for example, public
libraries and the academic sector.
Developing Integrated Knowledge Services for NHS Scotland:
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
Librarians and managers need to be encouraged to review workload priorities in the light of
the changing nature of Knowledge Services.
The following responses will, hopefully, begin to address some of these issues in the near future:

A Training Needs Analysis to be conducted in NHS Tayside during the first half of 2004, a
representative sampling process being adopted to enable this study to serve as a model for
training needs more generally across NHS Scotland.

We have been fortunate in having the support, as Information Scientist within NHS
Education, of Alex Haig, who has been engaged to carry out over 20 training sessions in
various NHS Boards during the latter half of 2003/2004. The business case for full-scale
development of the e-Library recognises, however, that the scale and complexity of training
need requires dedicated personnel and substantial resource investment at both local and
national level. During 2004, as a preliminary step in this direction, we will appoint an eLibrary Training Coordinator, to support NHS librarians and other trainers through provision
of training resources and to focus particularly on primary care and remote and rural
information skills needs.

Implementing the commitments to end-user and librarian training negotiated with suppliers
within the 2004/5 contracts for subscription resources.

Further “How to teach” sessions for NHS librarians, following up on an initial training
session during 2003.

Debate around training issues at the Communicators’ Group and Marketing and Outreach
Group identified a number of ways in which local and national training could inter-relate
more effectively, including: development of specialist training roles within the librarian
community; targeting of low-usage groups; improved evaluation of impact and sharing of best
practice and resources.
7. Promotion and Outreach
7.1 Closely linked with information skills training, promotion and outreach are patently key to the
success of the e-Library and form part of the proactive approach to Knowledge Services
generally as advocated in the new strategy. Like information skills training, promotion and
outreach are dependent upon concerted national and local contributions, and success depends
upon generating a sense of responsibility and ownership among the full range of stakeholders,
including managers, librarians and other disciplines.
7.2 The Marketing and Outreach Group organised large-scale production of promotional materials
for the launch of the e-Library in January 2003. These have been distributed widely through the
mediation of library services, professional organisations, conferences and visits to local services
by the e-Library team.
7.3 Subsequent to review of the past year’s activities and e-Library uptake within the Marketing
and Outreach Group and the Communicators’ Group, the following developments have been
agreed for the coming year:

Identification of individuals to act as “Marketing Links” within individual NHS Boards, with
responsibility for disseminating e-Library promotional material to the various library services,
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and for development of local marketing strategies, based on the template provided at the
“Marketing your Library Service” study day.

Closer working with Communications Officers within NHS Trusts and Boards, initially via
the Association of Healthcare Communicators.

Further development of the Marketing and Outreach Group to include representation by
professional Communications Managers and IT Trainers, increased interaction with local
Marketing Links as described above, and improved definition of the strategic framework for
e-Library promotion and outreach.

Creation of e-Library User Groups at NHS Board level, coordinated by a nominated local
NHS librarian and drawing upon existing stakeholder groups. These groups will provide a
focus for feedback on the redesign process for the e-Library.
7.4 With regard to the important issue of improved outreach to primary care, two projects are
currently in hand:

An “Away Day” organised by the West of Scotland General Practice Education Unit to
consult with NHS Librarians on challenges in meeting primary care knowledge needs.

A trial organised with BMJ Publishing and the South East Scotland General Practice
Education Unit to promote and evaluate usage of the Clinical Evidence compendium in
general practice and community pharmacy settings in NHS Fife, NHS Lothian and NHS
Borders.
8. Development of the NHS Librarian role
8.1 It has been recognised from the first that further development of the librarian role is
fundamental to realising the vision of Knowledge Services fit for purpose for a modernised
health service.
8.2 Training and development for NHS librarians during the past year has focused on three
aspects:
1.) Support for the Communicator role in promoting the principles and priorities of NHS
Library Service development at local level. It is recognised that the Communicator role in itself
represents a significant new professional development opportunity for NHS librarians. Events
organised specifically for Communicators, some taking place during the monthly meetings of this
Group, have included:


A two-day training programme on negotiation and presentation skills
Developing a Strategy for Knowledge Services – Study Day organised by University of
Strathclyde Business School.
In addition, several of the monthly meetings of Communicators have centred on workshops
facilitated by group members and preceded by presentations on the issues in question. Themes for
these workshops have included:


Developing a Coordinated Service
The Changing Role of the NHS Librarian
Developing Integrated Knowledge Services for NHS Scotland:
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16

Promotion and Training for the NHS Scotland e-Library
2.) For the wider librarian community, training has focused on supporting expert search skills,
proactive promotion and teaching skills as key aspects of modern NHS Knowledge Services.
The ADEPT distance learning course on advanced literature searching, offered by the School of
Health-Related Research at the University of Sheffield, has been offered to all NHS Boards.
Twenty three librarians are currently taking advantage of this opportunity. The Training and
Development Department within NHS Education has organised one-day training sessions on
Marketing the Library Service and How to Teach. All sessions have been well-attended and
evaluated highly.
3.) Additionally, providers of e-Library subscription content have provided regionally-based
training sessions for librarians, as follows.








EBSCO suite of databases – librarians invited to organise training sessions for each NHS
Board.
EMERALD, Science Direct – three one day training sessions covering both resources.
ASSIA, LISA, Martindale and Stockley’s Drug Interactions - three one day training
sessions covering all resources
MD Consult – three half-day training sessions
RefWorks - three half-day training sessions
Health Estates Portal – three half-day training sessions
ProQuest suite of databases – librarians invited to organise training sessions for each NHS
Board.
Web of Science – three half-day training sessions
8.3 With regard to the personal as opposed to the organisational, technological and professional
changes involved in the current development process, two one-day courses on Making Transitions
out of Change have been offered. These provided valuable insights into the effective management
of change at an individual level.
8.4 The appointment of a part-time Staff Development Manager during 2004 should enable us to
tailor librarian training and development more specifically to the needs of Knowledge Services in
the fast-changing NHS environment.
8.5 As a complementary approach to development of the librarian role, the Job Descriptions
Group, comprising NHS librarians with a specific interest in professional development, has
created a set of generic job descriptions for a range of professional roles, based upon the vision of
integrated and modernised NHS Knowledge Services 15 . These job descriptions are currently
undergoing evaluation within the Agenda for Change process. It is hoped that this exercise will
form the basis of a more equitable approach to grading of NHS librarian posts, and will enrich
understanding of the librarian contribution to the work of the health service.
9. Conclusion
9.1 The past year has been one of unprecedented change and development for NHS Knowledge
Services. The primary objective has been to establish the principle of an integrated national/local
approach to service modernisation as essential to meet the needs of health care delivery in the
twenty-first century.
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9.2 The strategic vision put forward by NHS Education is based on development of the NHS
Scotland e-Library as a key component of the new knowledge infrastructure and on the
concomitant development of the librarian role. The core principles defined for service
development have demonstrated their staying power in the face of challenges and a degree of
conflict during the past year.
9.3 The basic objective of integrated knowledge support for a cost-effective, modern health
service is now firmly established. What seems to be called for in the new development phase from
January 2004 onwards is some shift of emphasis towards a higher, nation-wide strategic profile
and fuller recognition of the impact of Knowledge Services on health care outcomes, involving
new partners to achieve a wider sense of ownership and spirit of deeper integration with the
health service as a whole. As always, your continued support as managers, stakeholders and
service users will remain essential during the coming year to consolidate achievements to date,
supporting the sustained growth of Knowledge Services for NHS Scotland, and their increasing
contribution to a holistic system of healthcare delivery.
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10. References
1. Discussion paper: the nature of future strategy for management of the knowledge base of
healthcare for NHS Scotland 2003-2006. NHS Education for Scotland, 2003.
2. Development of Knowledge Services for NHS Scotland: Strategic Overview NHS Education
for Scotland, 2003.
3. Strategic direction and role of NHS Education in development of Knowledge Services for NHS
Scotland. Recommendations approved by Executive Board of NHS Education for Scotland, 22
October 2003. NHS Education for Scotland, 2003.
4. Enabling Access to the Knowledge Base of Health Care: a review of NHS Scotland Library
Services. Scottish Library and Information Council, 1997.
5. Survey of UK NHS Library Service activity and funding 2002- 2003 (unpublished data). NHS
Library and Knowledge Services Development Network, 2003
6. Guidelines for the development by NHS Boards of integrated strategies for management of the
knowledge base of healthcare. NHS Education for Scotland, 2003.
7. Template for production by NHS Boards of integrated strategies for management of the
knowledge base of healthcare NHS Education for Scotland, 2003.
8. Burnett, S., Webster, L., Williams, D. The nature of future strategy for Library and Knowledge
Services for NHS Scotland: a preliminary analysis of user needs. Robert Gordon University,
2003.
9. Burnett, S., Webster, L., Williams, D. Access to the knowledge base to support
interdisciplinary models of healthcare delivery. Robert Gordon University, 2003
10. Modernising the Knowledge Infrastructure for NHS Scotland: Business Case for Development of the
NHS Scotland e-Library 2005-2010 (draft) NHS Education for Scotland, 2003
11. A Standards-Based Knowledge Infrastructure for the NHS Scotland e-Library NHS Education
for Scotland, 2003
12. Thain, A. Managed Knowledge Networks for Cancer, Coronary Heart Disease and Mental
Health: Project Outline. NHS Education for Scotland, 2003
13. Haig, A. e-Library training: an overview. NHS Education for Scotland, 2003.
14. Digest from Communicators’ Meeting, 28 October 2003 . NHS Education for Scotland, 2003.
15. Generic job descriptions for NHS Librarian roles
http://www.elib.scot.nhs.uk/news/pages/librariannews.asp
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