iclc birmingham june 2011 lisa lawrence clinical librarian, derby hospitals nhs foundation trust the...

ICLC Birmingham June 2011

Lisa Lawrence

Clinical Librarian, Derby Hospitals NHS Foundation Trust

The Role of a Clinical Librarian:

The Role of a Clinical Librarian:A Diffusion of Innovations Interpretation

Aims

Clinical librarianship as an innovation in UK health librarianship

Postgraduate dissertation, submitted September 2010

Reasons for the study

Rogers’ Diffusion of Innovations theory

Literature review

Methods

Findings

Conclusion

Any Questions?


Reasons for the study

Postgraduate dissertation.

Clinical librarian at Derby Hospitals – interested to know more

about UK CL services.

Purpose - To investigate the role of the CL in the UK, within the

context of Rogers’ Diffusion of Innovations theory.

Objectives - investigate roles, establish commonalities/disparities,

gain a better understanding of current implementations through

use of DOI.

Provide a picture of awareness levels of CL services and any

consequent effects on diffusion and adoption of the role.


Rogers’ Diffusion of Innovations (DOI) Theory

Rogers, E. M. (2003). Diffusion of Innovations. (5th edition) New

York: Simon & Schuster.

“Getting a new idea adopted, even when it has obvious

advantages, is difficult. Many innovations require a lengthy

period of many years from the time when they become available

to the time when they are widely adopted”


Rogers’ DOI Theory

Rogers describes an innovation as

“an idea, practice or object that is perceived as new by an

individual or other unit of adoption”

Rogers interprets diffusion as

“the process in which an innovation is communicated through

certain channels over time among the members of a social

system. It is a special type of communication, in that the

messages are concerned with new ideas. … The newness of the

idea in the message content gives diffusion its special

character”


Aspects of DOI Theory

Communication:

Interpretation; Perception; Situation

Time

Adoption or Rejection

Innovation-decision process:

Knowledge; Persuasion; Decision; Implementation;

Confirmation.

Adopter-categories:

Innovators; Early adopters; Early majority; Late majority;

Laggards.

Rate of adoption



Measure of control over process?

Social system structure – e.g. hierarchical

Innovation decisions:

- Optional innovation-decisions

- Collective innovation-decisions

- Authority innovation-decisions

- Contingent innovation-decisions



Consequences of adoption or rejection:

1. Desirable vs undesirable

2. Direct vs indirect

3. Anticipated vs unanticipated

Characteristics of innovations:

1. Relative advantage

2. Compatibility

3. Complexity

4. Trialability

5. Observability



Rogers states:

“Innovations that are perceived by individuals as having greater

relative advantage, compatibility, trialability, and observability

and less complexity will be adopted more rapidly than other

innovations. Past research indicates that these five qualities

are the most important characteristics of innovations

in explaining rates of adoption”


DOI – a suitable framework

Evaluations of pilot projects saw CL

services as an innovation

Are CL services diffusing in the UK?

DOI theory – suitable model to use


Literature Review

What is clinical librarianship?

Background of clinical librarianship:

- USA experience

- UK experience

“Typical” role of CL

All examined within the DOI

framework


Literature Review – Conclusions

“In terms of Rogers’ characteristics of innovations, the innovation of clinical

librarianship in the UK offers a small body of evidence, currently suggesting

• Relative advantage - Some indications of cost savings and more

effective EBP.

• Compatibility - Consistent with trends in healthcare and health

librarianship.

• Complexity - No consistent model of practice, perhaps

making widespread roll-out more difficult?

• Trialability - Multiple pilot projects allow opportunity for

experimentation - perception of

adaptability?

• Observability - Accumulating evidence base helpful”


Literature Review – Conclusions

Some central recognition of importance of CL role.

UK CL projects mainly contingent innovation-decisions.

Widespread knowledge, but consequences of implementations

require further understanding.

- CL project evaluations consistently confirm Desirable aspects

- Direct/Indirect changes (individual/social system) not yet entirely evident

- Unclear exactly what Anticipated and Unanticipated consequences occur.

Further research is called for in order to clarify these issues.

Methods

Methods:

Online questionnaire, Follow-up Focus Group

Analyses undertaken using online survey software for

quantitative data and thematic analysis for qualitative

information.

Ethics:

Approval from Research Governance

Consent from organisations/participants

Data protection/anonymisation



Methods

Online questionnaire

Piloted, amended, then sent to potential 45 respondents

Focus group

Smaller group, more detailed

discussion, themes arising from

questionnaire responses


Questionnaire Findings

Response Rate

- 20 partial responses (44%) response rate

- 17 complete responses (38%) response rate

Clinical Librarians

- 70% respondents CL service established 3 years+

- 65% respondents involved in their service for up to 3 years

- Some variation in job titles/job roles



CL Services

- Core services and optional services

- 7 respondents (36.8%) using “clinical champions”

- Variety of teams as first team/dept. supported

- Core services as initial provision

- Not all current CLs aware of initial CL services

- Initial services shaped according to clinician preference

- 52% respondents indicated services changed over time

- Clinician or library led changes



CL Opinions & Awareness of Perceptions of CL Services

- Mixed opinions

- General belief clinical teams/departments pleased

- Less direct evaluation available

- Feedback indicates services valued

Best aspects of CL services – greatest impact?

- Literature searching core

- Current awareness/training actually reaches more users?

- Value of interaction in department



Effects on library

- Library staff expectations of CL service changed over

time

- Changing situations, necessitate realistic service

delivery

- Modify and adapt service according to:

- clinical teams needs/expectations

- library staff needs/expectations

- Generally not encountering unforeseen consequences



Service Users

- Variety of staff and students

- Heaviest users generally medical staff

- Least usage among administrative/non-clinical staff

- Some CLs (59.2%) indicate change in usage over time



Service developments

- Small adaptations as required

- No wholesale changes to service model

- Progression to supporting more teams both library-led

and clinician-led

- Some services have plans for future development

- Influence of external factors



Service awareness

- CLs believe some service awareness in their

organisation

- No total unawareness

- Only 1 respondent indicated complete awareness

- Board level awareness in some organisations

- CL perceptions or truth?

- Actual knowledge or guesswork?

- Further marketing of services required?



Advantages of CL services to teams and organisations

Time saving for clinical staff

Best use of each professional’s skills

Supports EBP

Supports a questioning culture

Better informed staff should lead to better patient care

Awareness of need to prove the value of library services as a whole –

need to demonstrate impact


Focus Group Findings

DOI Theme: Desirability, Adaptability, Trialability, Observability

- Anticipated themes: Roles & Responsibilities, Tailoring

- Emergent theme: Empowerment

All participants CLs by job title and role

All slightly different experience of clinical librarianship

All participants chose to tailor services

Although CLs sometimes feel undervalued, unproductive, also a

sense of empowerment



DOI Theme: Compatibility and Relative Advantage for Individual

Teams and Wider Organisation

- Anticipated themes: Advantages, External Influence

CLs save clinicians time!

Improving practice

Improving skills



All participants felt role helps to

market library – “public face”.

External circumstances/decisions

have significant impact on decisions

made within CL service.

Emphasise need to demonstrate the

value of the service in a time of

economic uncertainty.



DOI Theme: Consequences – Anticipated & Unanticipated

- Anticipated themes: Consequences

Accepted any consequences as natural outcomes of their work.

Embraced outcomes positively, regardless of expectations and

workload demands.

Participants identified the need for peer support, advice and to

share practice as a consequence. Highlighted importance for sole

CLs.



DOI Theme: Perception / Awareness

- Anticipated themes: Awareness Variation, Perception (CL)

- Emergent themes: Awareness (Library), Perception

(Library)

Library staff awareness can be problematic, some colleagues are

aware, but no real understanding of aims/purpose.

Awareness variations – served departments better than wider

organisation.

Acknowledged need to improve awareness, particularly with

managerial staff and/or budget holders.



Participants emphasised the need for wider representation

Participants suggested sometimes symptomatic of perceptions of

library services as a whole.

CL services part of the whole library service, need that foundation

to function effectively.


Summary Findings

CLs have varied job titles, roles and responsibilities.

The role is tailored according to the needs, requirements and

desires of clinical teams and organisations.

CLs provide a quality role to their organisation.

CLs feel empowered in their roles

CLs understand the effects of external influences on their services.

Awareness levels vary, both at individual and organisational levels,

and within and without the library.

Need to address perceptions of library services.


Conclusions

DOI theory provided a good framework for examination of CL

services. Specific themes could be investigated.

Adaptable/trialable nature of the role – a strength (a relative

advantage), rather than a weakness? Aiding diffusion of the

innovation?

Relative advantage also in the quality role the CL fulfils.

UK CL projects remain contingent on other decisions. Emphasis

on need to evidence and prove the value, impact and worth of the

role.

Need to improve awareness and perceptions.


Any Questions?


Thank You

Huge thanks to all those who participated in my

research project!

Thanks to all of you for listening today.

Further information:

Lisa Lawrence

Royal Derby Hospital

[email protected]

iclc birmingham june 2011 lisa lawrence clinical librarian, derby hospitals nhs foundation trust the...

Documents

typical role

doi framework slide

observability slide

rates of adoption slide

rate of adoption slide

optional innovationdecisions

authority innovationdecisions

use of doi