All for one, one for all: collaboration between NHS and Higher Education in establishing provision of a multi-disciplinary, hospital-based library and information services

© Health Libraries Group 2004

Health Information and Libraries Journal

,

21

, pp.39–45

39

Blackwell Publishing, Ltd.

All for one, one for all: collaboration between NHS and Higher Education in establishing provision of a multi-disciplinary, hospital-based library and information services

Coral

Black and Rachel

Bury, Edge Hill College of Higher Education, Ormskirk, Lancashire, UK

Abstract

Developing multi-disciplinary library and information services is high on theagenda for many NHS trusts and this brings with it a climate of change for boththose who manage and work in services today. The development of such newservices needs to be carefully managed and developed, and this presentsa challenge for librarians and service managers. In the UK during 1999 and2000, Aintree Hospital Trust, in conjunction with Edge Hill College of HigherEducation, established a truly multi-disciplinary service based at its hospitalsite and managed by Edge Hill. This paper outlines the key stages in the devel-opment of the Library and Information Service with the focus on the manage-ment of change, collaboration and the development of a unique partnershipbetween Higher Education and an NHS trust. The case study example willprovide an outline of strategic and project planning, with insights into staffmanagement and development, delivering user expectations and developingstakeholder relationships in the health library setting.

Introduction

Following early National Health Service (NHS)drivers, the development of multi-disciplinary libraryservices has been high on the agenda for manyhospital trusts for a number of years.

1

More recently,this has been the result of hospital mergers andre-organization of hospital sites. The aim beingto develop a new type of library and informationservice able to cope with the increasing demandsplaced on it from all areas of the NHS.

2

Suchdevelopments raise a number of questions that arediscussed in this article: where will the new servicebe located, who will have access, how will the servicebe managed and how are partnerships developed?

This paper outlines the key stages in the develop-ment of such a multi-disciplinary service with a remitto provide information services to local hospitaltrusts, two Higher Education Institutions (HEIs)and the local Primary Care Trust. This uniquepartnership, with Higher Education managing anNHS Library Service is possibly one of the firstin the country, and has resulted in the collabora-tion of very different stakeholders to ensure thata responsive, quality service is delivered to allusers. The success of this partnership is predicatedon effective partnership and strategic planningbetween the NHS and Higher Education, withstakeholder involvement at its core.

This paper will explore the development processfrom the original conception through project planningto the service becoming fully operational. The focuswill be on the role of staff in the planning and

Correspondence: Coral Black, User Services Manager, Edge Hill Collegeof Higher Education, St. Helens Road, Ormskirk, Lancashire, L39 4QP,UK. E-mail: [email protected]

Developing multi-disciplinary library and information services,

Coral Black and Rachel Bury



,

21

, pp.39–45

40

management of the project, looking at how issuesaround collaboration have been managed and howaspects of the partnership have developed. The paperalso draws on the literature of the discipline, espe-cially in relation to multi-disciplinary NHS libraries,the management of change and partnership working.

Context

NHS agendas and multi-disciplinary approaches

The most recognized driver for change is the HealthService Guideline (97)47.

1

This clearly states ‘thatall staff should have access to a multi-disciplinarylibrary and that it is the role of NHS trusts to drawup a library and information strategy covering allstaff groups’. The guideline also encourages partner-ship between NHS libraries and HEIs.

In the UK in 1997 the north-west region com-missioned a study to develop a strategy for libraryservices in the north-west of England.

2

The fullreport and executive summary were published inApril 1998 with the identification of nine recom-mendations to form a framework for change. A keyrecommendation highlighted the need to ‘commis-sion a corporate multi-disciplinary library andinformation service’ with the aim of providing amore strategic approach to meet the needs of theNHS community including Trusts, Health Author-ities and General Practice. The report also indi-cated that such services could be managed withinexisting Trusts or contacts could be establishedwith HEIs. The report concluded that this newapproach did present a challenge to librarians andlibrary services managers, but that the need forbetter information provision across the NHS sec-tor was an overriding factor in the need for change.

A survey and case study in 1995 at City HospitalsSunderland NHS Trust found that staff supportedthe idea of setting up a multi-disciplinary library.

3

Thedevelopment of small specialist and departmentallibraries is seen as a risk and a multi-disciplinaryservice can provide extra benefits with the moreefficient use of resources, reduction of duplication,breaking down barriers between professionals andproviding access to each others specialized stock.

The climate for change and a move towards multi-disciplinary was at its height in the late 1990s. In1995 Carmel was optimistic for the future with a

paper entitled

Thriving amid chaos: health care andlibrary services in the 1990s.

4

He raised the issueof contracting out for services and thought thatlibraries should develop this concept, incorporatingservices for both doctors and nurses. He was con-cerned that ownership of medical libraries by doctorswas a threat to the development of multi-disciplinarylibraries, and that contracts that specify servicesfor a range of users and agrees funding mecha-nisms was a move in the right direction and shouldbe encouraged.

Although the Aintree site had four separateservices covering all aspects of nursing, science andhealth, there was no multi-disciplinary approach andissues around access were harbouring negativitytowards organizations. As Haldane questions ‘Dothe priorities of higher education and the multi-disciplinary agenda of the NHS conflict with orcompliment each other?’

5

Issues already beingdiscussed with HEIs around location and access,quality of provision and management efficiencybecame even more prominent with the developmentsin NHS information provision. The NHS was striv-ing in the late 1990s to address inequality of libraryprovision for its staff and provide multi-disciplinaryresources from their traditional medical ‘libraries’.

6

Management of change

Hudson argues ‘Libraries like many other institutionshave been experiencing change at an acceleratingrate’.

7

Most have experienced one major changein recent years and coping with this is a commondiscussion topic. Change can result from serviceconvergence, systems migration, new buildings andre-structuring. The process of managing any one ofthese situations is crucial in the success and develop-ment of the service. A whole range of skills needsto be incorporated by librarians and managersto effectively manage the process of change and toguide staff through the transition period. Developingan inclusive decision-making style, fostering positiveemployee attitudes towards change, and utilizingeffective communication skills can help make changea more positive experience.

7

In managing change itis recognized that a strategic approach to humanresource development is essential in terms of success.It is often this area that is overlooked within theoverall process and can result in negativity and





,

21

, pp.39–45

41

de-motivation of staff.

8

The impact of changeon service staff and customers should be viewedas extremely significant, consequently the import-ance of effective communication cannot be under-estimated. In a project where multiple stakeholdersare involved, listening to their concerns is crucialto future success.

Techniques for making change a more positiveexperience include support for everyone in the teamduring the transition rather than focusing on thosewho have a specific role in the process. Managersneed to be aware of the timing and frequency ofinformation provided as well as the content and,above all else, honesty is needed. Questions staffwill want answered include, why do we need to change,will it affect me, when will it happen, and what willit mean?

9

Moving to new premises with a completechange of policies and procedures for some groupsof users could create further negative attitudestowards new services. However, Haldane states thatidentifiable improvements to the quality of serviceswill overcome initial resistance to change.

5

Within the remit to develop multi-disciplinaryservices, collaboration between stakeholders is keyto success.

The New NHS—Modern and Dependable

made clear that there was to be greater collabora-tion and co-operation between NHS and non-NHSorganizations.

10

Projects in this area have beenwell documented. A conference in 2001 highlightedexamples of best practice of collaboration in healthlibraries.

11

At the same time, a British Libraryreport documented the work of Sue Childs andoutlined the partnership working taking place inthe north-east of England.

12

These projects havefocused on improving the availability of libraryand information services across a number of largegeographical areas, whereas the service at Aintreefocuses on providing a single physical library andextensive electronic resources to a number of HEand NHS users. However, the issues are similar inthat there needed to be a joined-up way of thinkingfor management, access, funding and development.

Within an environment of partnership and co-operation, and a shared goal, organizations canwork together. This case study will outline how thosestrong links can be forged and how it is possible toachieve the truly multi-disciplinary library, servingthe needs of diverse users, without the exclusion oralienation of any one group.

Case study

Edge Hill College of Higher Education

Edge Hill is an HEI in the north-west of England,with 9000 students on a range of degree and diplomacourses and a further 6000 on continuing professionaldevelopment courses, particularly in education andhealth-related areas. Edge Hill has strong centralizedacademic support structures enhanced by the recentformation of Learning Services.

The Faculty of Health Studies is based on threesites, the largest being Aintree. The portfolio ofcourses covers Pre-Registration Nursing and Mid-wifery, Post-registration, Continuing ProfessionalDevelopment, Operating Department Practice andmasters level programmes. The Faculty currentlyhas 1122 pre-registration and 1473 post-registrationstudents.

Learning Services incorporates learning resourcecentres and information provision, learning support,ICT support for learning and teaching, e-learningdevelopment and support, media services, and dis-ability and dyslexia support. The service is predom-inantly based across three sites within Lancashireand Merseyside, but with an increasing growth inoff-campus provision across the region and beyond.Provision for health studies is focused mainly onthe Aintree University Hospital site with furthersupport and services available on the Ormskirk site.

Aintree Hospital NHS Trust and the Walton Centre for Neurology and Neurosurgery NHS Trust

Aintree Hospitals is a large acute trust basedprimarily on the University Hospital Aintree site,Merseyside, but with out-patient and day-casetheatres on the Walton site 3.5 miles away. AintreeTrust has 3596 employees, 910 in-patient beds and86 day-case beds. The University Hospital Aintreesite also has a specialist NHS Trust within its grounds,The Walton Centre NHS Trust. This trust has650 employees with strong links to the Universityof Liverpool Department of Neuroscience, whichis a Faculty not based on the main University ofLiverpool site. The potential user group for a newmulti-disciplinary library was therefore very diversewith high levels of expectation.





,

21

, pp.39–45

42

Implementing the new service—project outline

General outline

In 1998, with funding secured, Aintree HospitalsTrust commenced planning the new centre withthe focus on research and education. Following dis-cussion between Aintree Trust and Edge Hill aboutfuture library provision on the site, an agreementwas reached for a new multi-disciplinary resourcecentre to form part of the new building. This resultedin major change for those existing services that wereto be merged into one large, central service. Four exist-ing services supported staff and students on the site:

•

Edge Hill’s Nursing Library;

•

Aintree Hospitals Trust Postgraduate MedicalLibrary;

•

University of Liverpool undergraduate medicalcollections;

•

The Walton Centre for Neurology and Neuro-surgery NHS Trust and University of LiverpoolDepartment of Neuroscience collections.With different stakeholders involved, the Trust

recognized the need for one management structureto exist. A tender process followed with submissionby a number of interested parties and with EdgeHill being the successful application. The projectwas managed over a period of 12 months with thenew service to be operational in August 2000.

Involvement of Edge Hill staff started immedi-ately with inclusion on the project steering groupfor the new building and a full role in developing thespecification for the new Library and InformationResource Centre (LIRC). This was crucial in termsof the overall success of the project, with keyrelationships quickly fostered. It was importantthat, as a higher education provider, the needs ofthe other stakeholders whose existing serviceshad to be managed were understood.

Management issues

The management of this project from initial con-ception to a fully operational service was a complexprocess. The key areas of focus were:

Contract and service management.

A Service LevelAgreement (SLA) was drawn up following discussions

with the Head of Learning Services and TheDirector of Finance, Edge Hill and the DeputyDirector of Finance, Aintree Hospitals NHS Trust.There are a number of objectives within the agree-ment including funding, staffing, service provision,communication, consultation and the requirementfor a formal review process. The contract states thatEdge Hill will manage the service on behalf of theother partners. The SLA was fully discussed andagreed with all stakeholders during initial planningstages, which was important as it informed discussionand highlighted areas that needed clarification.

Collections, access, and facilities.

The new servicebrought together four distinct collections, whichcomplemented each other with little duplication.All items, print and electronic, are managed via theGEAC library management system. The integrationof the other non Edge Hill items onto the systemwas the first major part of the project. The teaminvolved with implementation came from bothservices and this approach allowed a cross-sectionof staff from both sectors to begin working togetherand also provided an early introduction to differentareas of stock and the GEAC system.

Access to e-resources was to be an importantdevelopment for NHS users. The centre has 50 com-puters connected to Edge Hills network with fullaccess to the Internet, e-mail and electronic resources.There are also four computers attached to theUniversity of Liverpool network, and one com-puter that can access NHSnet. Access to resourcesfrom staff workstations or home was an issue thatneeded careful management during the first yearof operation as user expectation was high. This hasbeen addressed over the last 12 months with theNational Core Collection and utilization of fund-ing to purchase items suitable for NHS use.

Staff management.

All staff who work in the LIRCare now employed by Edge Hill, with two existingNHS staff transferring under TUPE rules and thePostgraduate Librarian appointed to the post ofmanager for the new service. Within the tender pro-cess, a new structure was formulated with resultingchanges to staff contracts, hours of work and roles.Involvement of all staff at this stage in the processwas crucial in alleviating staff fears about changeand ensuring their understanding of planned





,

21

, pp.39–45

43

developments. This was done in a number of ways,through staff meetings, update sessions and indi-vidual sessions for staff to discuss new roles,working patterns or raise individual concerns. Duringthe planning stages, staff continued to work acrossa number of locations, but a process of job shadow-ing was introduced so that staff could meet, shareexperiences and observe daily duties. Job shadowingalso allowed staff to experience the cultural differ-ences of the two services and to reflect on changesthat they would experience with the formation ofthe new service. All staff attended a number ofawareness-raising sessions and customer-care sessionsto ensure full understanding of the new service.

User expectation.

Managing user expectation wascrucial, especially in the months prior to the newcentre opening. Service users needed to be clear aboutwhat to expect in terms of services delivered, resourcesand changes to current policy and procedures. Itwas anticipated that a number of the new policiesand procedures established for the new servicewould be a culture shock for some users and itwas important to be aware of this and manageany issues that arose. This was done in a numberof ways, through publicity and general promotionacross the stakeholders, attending meetings toupdate key staff and inviting people into the centrefor tours. Teething problems included: long standinglibrary users having to re-join to allow a new recordwith the correct details to be added, access to photo-copiers and printers via pre-payment, and the useof accounts to handle departmental interlibraryloans and photocopying.

Stake holder involvement and ownership.

Buildingpartnerships and ensuring stakeholder involve-ment was a vital part of the process and one thatis ongoing. The SLA stipulated that an AdvisoryPanel would be established to meet regularly withall stakeholders represented. The panel is chairedby the Head of Edge Hill’s Learning Services andthe group operates at a strategic level, with discus-sion around developments, budgets and fundingstreams. An e-mail user group was established,utilizing JISC mail. It was intended that core usersof the service could be involved in disseminationof news, discussion of operational issues and ideasfor service developments.

A number of senior staff from within the LIRCare involved in meetings across both HE and theNHS and Aintree LIRC has a strong presence withinnorth-west-wide NHS library groups. This hasensured that the service and the library are kept upto date with developments and ensure its identityas an NHS library and information service. Thiscould have been an area of concern for NHS usersas the service is managed by an HE provider, butfeedback has shown users feel very positive aboutthe new service.

Critical success factors—what has worked?

From the outset, monitoring and evaluation ofthe new centre has been a vital part of the projectand has allowed further review and developmentof services. The new service has been a successand this is demonstrated in the cognitive feedbackreceived from stakeholders and service users. Thelevel of use for the new service has exceeded theplanned turnover with visitors per month regularlyin excess of 9000. In reviewing the main successfactors in managing the project, the following canbe identified:

Management of change.

This has been an ongoingprocess that has continued after the centre wasoperational. The project team set out clear objectiveswith realistic timescales for completion. Issuesand difficulties raised either from our staff or thestakeholders where discussed and resolved through-out the project. The early involvement of all staffin the planning process, project work and promo-tional activities ensured both engagement and interestin the developments. Staff morale remained highthroughout the project with staff feeling a realpride in the new service.

Staff development.

Whilst ensuring staff areinformed and involved in the process of change, itwas felt that a range of staff development activitieswere necessary to develop both staff skills andawareness around the new centre, with specific focuson the different user groups, extensive resourcesboth printed and electronic, and cultural issuesaround HE and NHS needs. Staff development iscrucial in the overall process of managing change,not only in terms of developing staff skills but also





,

21

, pp.39–45

44

in ensuring staff are comfortable with taking onnew roles and dealing with new work practices.

Communication and collaboration.

There is opencommunication with service users and a numberof formal mechanisms are in place to obtain userfeedback. The Suggestions Scheme allows user tomake a comment or complaint about the serviceand these are dealt with, and responded to withina set time frame. The Annual User Survey is under-taken each year along with the production of theAnnual Report. These formal mechanisms allowsenior staff and the LIRC Advisory Panel to gaina wide range of feedback from users. This informsservice change and development, which in turn isdisseminated widely to service users.

Collaboration has been a key part of the successof the LIRC and staff have been involved witha number of project groups. The Collections teamand Learner Support team have worked with stafffrom the Trusts IT departments and Training andDevelopment around the facilitation of e-resourceand the delivery of both generic and specialist learnersupport.

Could do better—what didn’t work?

Centre issues—noise, ICT facilities, group studyareas.

A very busy resource centre can be noisyand general issues around noise levels and mobilephone use have had to be managed. The increasein use also brought together medical and nursingstudents in the one location with different expecta-tions about what constitutes a conducive learningenvironment. There is now a Quiet Study Initiativein place, designated areas for the use of mobilesphones and a discrete area for silent work only.

As managers of the new service and the newspace, Edge Hill had highlighted a number of con-cerns at the planning stages around the smallamount of study space and no facilities for studentsto undertake group work. Problem-based and grouplearning, which is used widely by all students, doesrequire space to use resources and preparationfor presentations. Originally this was not availableand the space has had to be used creatively. Recentchanges to the environment and a reduction inshelving has released a space for group activities totake place.

The majority of the issues that have been raisedabout the centre are very much operational issuesthat need to be resolved within a short space of time.Discussion with stakeholders is not always possiblewithin the time frame that is required to find asolution. In many instances it is the staff managingthe service that need to make the decision on thespot. While this may not always be ideal in termsof collaboration, it is essential in terms of effectivemanagement of the service. Any changes that aremade are then later discussed at the advisory panelor through individual discussions with stakeholders.

Level of use by NHS staff.

A number of factors haveresulted in a lower than expected use level for NHSstaff. Areas identified through discussion with staffinclude limited opening hours, range and deliveryof electronic resources and low levels of awarenessgenerally. In response to this, the opening hourswere extended in the evenings and more recentlyon Saturdays. A full colour publicity brochurewas produced and distributed to all NHS staffto coincide with the launch of the National CoreContent and also the re-development of the LIRCweb pages with a number of additional resourcesfor our users. The number of registered users forthis staffing group has encouragingly risen yearon year.

LIRC user group e-mail.

The LIRC Advisory Panelworks very much at a strategic level and to com-pliment this group and feed issues from the bottomup, it had been discussed that there should be anoperational group with representation from users.With a diverse client group, establishment of sucha group to meet regularly proved difficult. The solu-tion to logistics and formal meetings was a virtualuser group and a JISC mail group for the LIRCwas created.

The user group has only partially been a success.There was some difficulty in encouraging key groupsof users to get involved. There have been very fewissues that were raised via this platform and alsovery little discussion. Issues that have arisen haveusually been dealt with verbally. Issues that involveone stakeholder are dealt with on a one-to-one basiswith a senior representative. It is felt that problemsor ideas for development are solved much quickerif taken directly to the LIRC manager.





,

21

, pp.39–45

45

Access to information, statistics and LIRC reportshas been improved by ensuring that all up to datereports are available via the LIRC website. Withmore and more of our users accessing the extensiveresources made available via the web pages, thisseemed ideal for the Annual Report, SurveyReport and LIRC Strategy.

The JISC mail group is still in use but the AdvisoryPanel are aware and satisfied that users will find theirown channels to raise issues and make suggestions.

Conclusion

The development of the new Library and Informa-tion Resource Centre at Aintree has been a greatsuccess and provides a good example of how a servicemerger can work. Systems for service monitoringand user feedback are in place and allow for reviewand development. Within this context, the manage-ment of change has proved complex and is ongoing.With collaboration operating on a number of levels,senior staff, local and regional services have beendeveloped that complement each other. Service usersand stakeholders are provided with a richly resourcedcentre, access to trained staff and a wealth of elec-tronic resources. Rather than being a reductionin service quality, a considerably enhanced servicecan be provided. New opportunities for leader-ship development and skills enhancement forstaff have also resulted.

13

With the service now wellestablished, further development is now focusedon partnership agreements with placement centresand primary care trusts, off-campus support, skillsdevelopment and support for clinical governance.

References

1 NHS Executive.

Library and information services

. Health Service Guidelines HSG(97)47. London: NHS Executive, 1997.

2 NHS Executive (North West).

North West Health Library and Information Services Review

. Warrington: NHS Executive North West, 1998.

3 Childs, S. M. Developing multi-disciplinary library services in trust hospitals: a case study at the City Hospitals Sunderland NHS Trust.

Health Libraries Review

1996,

13

, 203–12.4 Carmel, M. Thriving amid chaos: health care and library

services in the 1990s.

New Library World

1995,

96

(1220), 28–34.

5 Haldene, G. C. LISTENing to healthcare students: the impact of new library facilities on the quality of services.


2003,

20

(Suppl. 1), 59–68.6 Goldbolt, S., Williamson, J. & Wilson, A. From vision to

reality: managing change in the provision of library and information services to nurses, midwives, health visitors and PAMS. A case study of the North Thames experience with the inner London consortium.

Health Libraries Review

1997,

14

, 73–95.7 Hudson, M. P. Conflict and stress in times of change.

Library Management

1999,

20

(1), 35–8.8 Corrall, S.

Strategic Management of Information Services: a Planning Handbook

. London: ASLIB, 2000, 208–10.

9 Mann, S. Communication is vital in a changing world.

Professional Manager

1998,

7

, 3.10 NHS Executive.

The New NHS—Modern and Dependable

. London: NHS Executive, 1997.

11 XXX.

A Confederated Future: Libraries for All the Talents, Exploring New Ways of Working, Sharing Good Practice and Planning the Future, York, September 19, 2001

. Available from: http://www.nyrlas.nhs.uk/confedfuture.htm (accessed March 2004).

12 Childs, S. & Banwell, L. Partnerships in health: effective access models to higher education and National Health Service libraries for health professionals and students.

A British Library Project funded under the Co-operation and Partnership Programme

.

Final report, February 2001

. Newcastle-upon-Tyne: Information Management Research Institute, School of Information Studies, University of Northumbria, 2001.

13 Regenberg, P. B. & Joyce, M. K. Surviving a merger: how four hospital libraries created a unified system.

Journal of the Medical Library Association

2002,

90

, 98–100.

http://www.nyrlas.nhs.uk/

Documents

All for one, one for all: collaboration between NHS and Higher Education in establishing provision of a multi-disciplinary, hospital-based library and information services