Guest Author: Lisa Huang, Central Park Campus Library, Collin College, McKinney, TX
I am grateful to the National Network of Libraries of Medicine South Central Region (NN/LM SCR) for providing the Professional Development Award, which enabled me to attend the all day workshop “The Evolving Librarian: Responding to Changes in the Workplace and Healthcare” held at the OU-Tulsa Schusterman Library, in Tulsa, OK on April 18, 2013. The workshop was taught by one of the leaders in medical librarianship, Michelle Kraft, senior medical librarian at the Cleveland Clinic and current candidate for MLA President-elect. Kraft is also renowned for her Krafty Librarian blog http://kraftylibrarian.com/.
Kraft discussed current and emerging forces shaping the healthcare landscape such as the Affordable Care Act (ACA), electronic health record (EHR), local community benefit, new tax laws, numerous technological changes and evolving expectations of administrators and library clients. The Great Recession has accelerated these issues as hospitals are being funded differently now. Non-profit hospitals must turn a profit to stay afloat due to increasing technological costs of the EHR implementation. Kraft’s lecture was immensely informative and explained why the local hospitals have accelerated their community engagement efforts to maintain their tax exemption.
I was struck by the similarities of funding between Collin College, a community college district, and hospitals. Collin is no longer being funded by student enrollment numbers; funding is dependent on graduation, completion, and retention rates of students. For hospitals, funding is dependent on patient satisfaction and success rate of providing health care services instead of the number of services performed or provided to patients. Compounding these changes is the shrinking number of personnel as institutions have their reduced staffing. Kraft encouraged the attendees to re-evaluate traditional time honored activities such as cataloging books for hospital libraries with a small print collection. Libraries must evolve with society and its nomadic client expectations of on demand services and resources.
An issue addressed repeatedly at the workshop is that librarians need to demonstrate value to their home administration because libraries are expensive or as someone calls them, a “black hole.” Administrators are not sure about the value of libraries because they do not bring in money; librarians need to change the perception of the library as an asset. Amid fiscally challenging times, the notion of libraries as time honored institutions is antiquated; libraries are up for staff reduction or closure. Kraft argued that librarians need to re-align library operations and goals with the administration’s goals, regardless if you work for a hospital, academic health sciences center, or a community college. Libraries need to conduct qualitative research that measures their return on investment and the impact of all their services such as literature reviews, library instruction; or, the value of their books to the clients. ROI calculators and library narratives should be common knowledge for librarians. Librarians tend to shy away from research or simply don’t have the time to conduct research, but they need to conduct mini-research projects to demonstrate value and track impact. Possible projects include literature searches that lead to improved patient care or decreased length of stay.
Other takeaways from the workshop:
The need to be aware of healthcare legislation changes from the local to national level.
Staying abreast of new roles for librarians such as data management, emerging roles with the EHR, patient education, and embedded librarianship. The profession is evolving and new identities of librarians are being written.
Be flexible as change is constant and inevitable.
Understanding when technology is disruptive or you’ve allowed it to be disruptive in your library?
I appreciated the opportunity to attend this workshop and much appreciation goes to Stewart Brower and the OU-Tulsa Schusterman Library staff for their gracious hospitality.
This table is not just a cool looking list of visualization methods, but it also uses the format that we are familiar with from the Periodic Table of Elements to organize the visualization techniques into different types and purposes.
For example, the chart is color coded from yellow to purple. The colors represent different kinds of visualization types: Data Visualization; Information Visualization; Concept Visualization; Strategy Visualization; Metaphor Visualization; and Compound Visualization (examples below). Scrolling over each box in the Table will bring a pop-up window with an example in it.
In addition, several other pieces of information about the methods are contained in this table. There are icons that show if the visualization method is process visualization (depicting a temporal sequence) or structure visualization (depicting conceptual relationships), and whether the different methods show macro patterns (overview) or micro patterns (detail), and finally whether the methods demonstrate divergent or convergent thinking. These can help you determine whether this visualization technique might be right for you.
Here are some examples from each of the main categories of visualization methods:
When demonstrating your library’s impact to your institution, you will need to organize all the data that you have collected – gate counts, reference statistics, cost/benefit analyses, anecdotal data, etc. – and present them to your administration in some format. Your goal is that your presentation gets the attention of your administration, makes the case that your library has a huge positive impact on the institution, and convinces them that support for the library needs to be maintained or increased.
Part 3 in the Demonstrating Your Impact series is called “Telling Your Story.” This section is about exploring the idea of using storytelling as a means of organizing your data and having the most impact.
Andy Goodman, the author of Why Bad Presentations Happen to Good Causes (free download http://www.thegoodmancenter.com/resources/) says that “stories are a terrific way to bring large issues down to ground level where people can get their minds (and hearts) around them. But after you have told your story, you must back it up with the numbers that prove you have more than one story to tell.” In this video of a Plenary address for the National Assembly on School-Based Health Care, Andy Goodman gives a powerful demonstration of the importance of storytelling in engaging decision makers: http://www.ustream.tv/recorded/15665748.
How can you take this concept of storytelling and apply it to the data that you have been collecting on your library? Cindy Olney, with the NN/LM Outreach and Evaluation Resource Center, describes a very do-able process in her April 17, 2013 SCR CONNECTions webinar, Once Upon a Time: Using Evaluation Findings to Tell Your Project’s Story (recorded webinar: https://webmeeting.nih.gov/p18217101/). In her description of how to organize your presentation, Olney suggests
analyzing the data that you have collected,
articulating the key findings from charts and graphs into sentences, and
deciding what the most important findings are
weave them into one of two story systems: Sparkline or Storybook
Sparkline: This system, described by Nancy Duarte’s in a TED Talk (http://www.ted.com/talks/nancy_duarte_the_secret_structure_of_great_talks.html), is designed for persuasive arguments (like convincing your employers to expand the role of the library). In this system, the presentation goes back and forth between the vision of what could be and the situation as it is now. The presentation ends with a call to action. This Sparkline system can be shown to underlay great persuasive speeches, such as Abraham Lincoln’s Gettysburg Address and Martin Luther King Jr.’s I Have a Dream speech.
Storybook: Olney suggests the storybook format is best for presenting the results of a completed project. Three important elements should be included for a good story:
a likeable main character in an undesirable circumstances
this main character takes steps toward improving those circumstances – their progress is rife with obstacles
at the end, the main character is transformed
Whether you use the Storybook or the Sparkline system, to keep your story interesting and memorable, Olney adds “don’t let the data get in the way of a good story – write your story, then weave the data into it.”
To demonstrate your library’s impact to decision makers, it can be helpful to bring your data to life with some great success stories: researchers that were helped by your librarians, doctors’ time saved, or patients understanding their follow-up instructions. Even better than success stories you tell your administration are stories told about your library by satisfied customers, for example, satisfied doctors whose time is valuable to their hospital as well as themselves, satisfied patients who can recommend your hospital to others, or satisfied researchers who can vote where their city dollars go. In addition, there is evidence that anecdotal data can influence the outcomes of decisions (http://mande.co.uk/2010/uncategorized/stories-vs-statistics-the-impact-of-anecdotal-data-on-accounting-decision-making/).
Part 2 in the Demonstrating Your Impact series is about collecting and telling those success stories. The Centers for Disease Control and Prevention (CDC) has a publication called Impact and Value: Telling Your Program’s Story http://www.cdc.gov/oralhealth/publications/library/pdf/success_story_workbook.pdf. This document is intended for program managers to provide steps they can use to systematically collect and create success stories: “with attention to detail, a system of regular data collection and practice, this tool can become a powerful instrument to spread the word about your program.”
According to the Impact and Value publication, stories should not be the main method of presenting data, but they put a face to the numbers of research and evaluation data: “What does it really mean when you report that you have provided ‘X’ amount of services to ‘Y’ amount of people? How are the lives of the program participants [or your library customers] changed because of your services?”
A great example of systematic story collection can be found in the article, “MedlinePlus and the challenge of low health literacy: findings from the Colonias project,” (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1773027/pdf/i0025-7338-095-01-0031.pdf) which describes a project funded by the National Library of Medicine in which community health workers, known as promotoras, were trained to help members of some Texas-Mexico border communities find health information using MedlinePlus. These promotoras were asked to collect up to two stories every week on how they used online resources to help residents with health concerns. The 157 stories that resulted from this technique were treated as data: thematically coded, checked for validity, and studied to show the degree of success of the promotoras project.
What to do with all this data? Stay tuned for part 3 of the Demonstrating Your Impact series: Telling Your Story
Understanding social media and working to build an audience via social networking tools such as Facebook or Twitter can be a bit a challenge for librarians and other organizations who want to start a presence in these areas. In May American Libraries published the article Understanding Social Capital by librarian and social media expert Laura Solomon. Solomon explains the value of social capital and that in many ways social capital is akin to credibility. To start a social media presence with no followers can be frustrating but building your credibility through the development of social capital is an important step to gaining followers and sharing your message.
Solomon points out that one of the pitfalls many organizations suffer in early attempts to engage users on social media is posting and sharing information that is only about their organization. Building social capital takes time and requires work. Solomon stresses that “building a social media reputation means giving back.”
Solomon provides details on several tips for engagement with users that can be used to build social capital through social media. She recommends the follow:
Thank your patrons
Ask for opinions
Offer links to other sites of interest
Retweet your followers (Twitter)
Always give credit
Provide information people care about
Monitor and respond to posts
Solomon goes on to provide some advanced tips for building social capital through the use of photos, customer service, and contests as tools to further audience engagement.
One of the main takeaways from the article for anyone looking to build social capital is understanding that in order to build social capital there is a demand for reciprocity. While promoting your organization’s programs it is equally important to use social media as a tool to promote other programs and highlight information that your audience is interested in, even if it comes from other sources. Pointing people in the right direction and engaging with users is an important part of growing social capital and earning creditability.
Are you looking for ways to demonstrate your impact to your administration? This is Part 1 in a 3 part series on demonstrating your impact.
The NN/LM MidContinental Region (MCR) has created three online tools that can be used to enable a library to put actual figures to their importance within an organization http://nnlm.gov/mcr/evaluation/tools.html.
CBA/ROI Calculator: Sometimes it’s a good idea to speak the language of the administration. Cost/Benefit Analysis (CBA) and Return on Investment (ROI) are measures used by financial managers to indicate if their money is going in the right place. In a cost/benefit analysis, the goal is to show how much benefit the organization receives for the cost of the library. For a cost/benefit analysis, the result is actually a number: the benefit to costratio. If $50 was spent and the benefits to the organization could be seen as worth $25, then the benefit/cost ratio would be $25/$50 or 1/2 (50 cents of benefit for every $1 spent). This would obviously not look good for your library. However, if you could show that for the $50 that was spent, the benefit to the organization could be valued at $150, then the benefit/cost ratio is $150/$50, or $3 of benefit for every $1 spent. This could make your library look like a real asset!
Return on Investment is a very similar concept. In order to get the final percentage, the benefit of an investment (minus the original cost) is divided by the cost of the investment. So using the figures from the second case above, if $50 had been spent and a $150 benefit was achieved, $50 is subtracted from $150 to show a total return of $100. Then dividing that by the original investment ($100/$50), equals 2.00 or 200%. A 200% return on investment would make your library look very good!
“How can I apply this to my library” you might ask? The CBA/ROI Calculator from the MidContinental Region does most of the work for you. You simply fill in the blanks with the cost of books, cost of staff time, time saved, etc., and the final costs, benefits and ratios are determined at the bottom.
Database ROI Calculator: The calculator above is mostly designed for the books in your library’s collection. The MCR also provides a CBA/ROI calculator for databases. Getting statistics for databases can be a little more difficult than for other library services. Databases are often bundled with other products, and vendors define use statistics in multiple ways that make if difficult to compare across databases. Nevertheless, the MidContinental Region has some helpful tips for deciding which statistics to enter.
Valuing Library Services Calculator: Isn’t this what we all want – to explain that our library services have a financial value to the organization? Using this calculator, you can assign a dollar amount to the services you supply based on their retail value. You type in the number of times a particular service is used, and the calculator multiplies it by the retail value of that service. And at the bottom, it sums up your library’s total retail value.
The MCR is gathering data for advocacy purposes. If you would like your data included, be sure to fill out the form completely including the CAPTCHA box, and hit “submit data.” Librarians everywhere will appreciate your thoughtfulness.
The NN/LM MidAtlantic Region (NN/LM MAR) is offering a webinar on the value of libraries, entitled, Making the Most of the Value Study
• Joanne Gard Marshall, Principal Investigator, Alumni Distinguished Professor, School of Information and Library Science, University of North Carolina at Chapel Hill
• Kathel Dunn, Coordinator, Associate Fellows Program, National Library of Medicine
This session will provide an update on new specialized reports that have been created using the Value of Library and Information Services in Patient Care Study results, as well as how to access and use the data set from the study. All the items discussed will be made available on the Value Study website. Joanne will also share the results of some advanced data analysis that demonstrate the added value of using the services of the librarian and the searching the library-provided resources in patient care.
The second part of the presentation will discuss ways of mining and using the Value Study data. Kathel Dunn from NLM will share the results of data mining that they have done on users of PubMed/MEDLINE and related resources. The study gathered extensive data on each of the information resources used to answer the clinical questions.
Participants in this session will be encouraged to share their own stories about how they have used or would like to use the study results.
Patient safety in hospitals is a topic important to everyone, but it can be difficult to understand all of the issues involved. The Agency for Healthcare Research and Quality’s Patient Safety Network provides a series of Patient Safety Primers to guide people through key concepts in patient safety: http://psnet.ahrq.gov/primerHome.aspx
There are over 20 Primers available. Some of the topics are:
Adverse Events after Hospital Discharge: Nearly 20% of patients experience an adverse event in the first 3 weeks after discharge, including medication errors, health care–associated infections, and procedural complications. http://psnet.ahrq.gov/primer.aspx?primerID=11
Checklists: Though a seemingly simple intervention, checklists have played a leading role in the most significant successes of the patient safety movement, including the near-elimination of central line–associated bloodstream infections in many intensive care units. http://psnet.ahrq.gov/primer.aspx?primerID=14
Diagnostic Errors: Thousands of patients die every year due to diagnostic errors. While clinicians’ cognitive biases play a role in many diagnostic errors, underlying health care system problems also contribute to missed and delayed diagnoses. http://psnet.ahrq.gov/primer.aspx?primerID=12
Disruptive and Unprofessional Behavior: Popular media often depicts physicians as brilliant, intimidating, and condescending in equal measures. This stereotype obscures the fact that disruptive and unprofessional behavior by clinicians poses a definite threat to patient safety. http://psnet.ahrq.gov/primer.aspx?primerID=15
Error Disclosure: Many victims of medical errors never learn of the mistake, because the error is simply not disclosed. Physicians have traditionally shied away from discussing errors with patients, due to fear of precipitating a malpractice lawsuit and embarrassment and discomfort with the disclosure process. http://psnet.ahrq.gov/primer.aspx?primerID=2
Nursing and Patient Safety: Nurses play a critical role in patient safety through their constant presence at patient’s bedside. However, staffing issues and suboptimal working conditions can impede nurses’ ability to detect and prevent adverse events. http://psnet.ahrq.gov/primer.aspx?primerID=22
Wrong-Site, Wrong-Procedure, and Wrong-Patient Surgery: Few medical errors are as terrifying as those that involve patients who have undergone surgery on the wrong body part, undergone the incorrect procedure, or had a procedure intended for another patient. http://psnet.ahrq.gov/primer.aspx?primerID=18
Patients also have a part to play in ensuring that they have safe healthcare, as described in the following Primer:
The Role of the Patient in Safety: Efforts to engage patients in safety efforts have focused on three areas: enlisting patients in detecting adverse events, empowering patients to ensure safe care, and emphasizing patient involvement as a means of improving the culture of safety. http://psnet.ahrq.gov/primer.aspx?primerID=17
Public libraries play an important role in the community year round, but during or after an emergency or disaster the public library is also an important resource for first responders. Public libraries provide important information centers in a community and are often equipped with computers, meetings spaces, and possibly access to the internet. After an emergency or disaster first responders working with their community public libraries can provide safe shelter spaces for survivors. In addition, public library technologies including computers, phones, printers, and internet access may serve as vital communication tools for survivors and first responders.
The video below was created by the National Network of Libraries of Medicine, South Center Region (NN/LM SCR) to demonstrate how public libraries and first responders can work together to ensure community well-being and safety before and after a disaster or emergency.
This week is National Library Week: April 14 – 20, 2013. The theme for this year’s observance is “Communities matter @ your library.”
Public, school, and academic libraries are busier than ever serving the people in local communities. They help people fill out job applications, provide homework assistance to students, offer public access to the Internet, assist small businesses in conducting research, and much more. Yet libraries face funding crises in many communities. Without proper funding, libraries are forced to decrease or cut resources, reduce the number of librarians and library workers, and reduce hours of operation. Even worse, some libraries face closures.