Mirage or reality?

Is evidence-based librarianship a mere buzzword— a fashionable concept to hitch to the ever-rising star of evidence-based practice? Is it, instead, a genuine attempt by librarians to impose a more rigorous and systematic framework on to their day-to-day decision making? This issue was at the centre of discussions stimulated by the first-ever Evidence Based Librarianship Conference held at Halifax Hall, University of Sheffield on Monday 3rd and Tuesday 4th September 2001. Rather than merely report the proceedings of the conference, however, this column will attempt to identify some overarching themes raised by this scene-setting event. Readers wanting to obtain a flavour of the individual papers making up the conference are referred to the Conference Website at http://www.shef.ac.uk/~scharr/eblib/conf.htm Many of the themes explored by the Conference were, in fact, raised at a Preconference Expert Seminar held on the morning of the first day. This limited invitation event, sponsored by the LINC Health Panel, aimed to assemble leading players from each of the NHS regions, senior librarians from major health libraries and librarians involved in multidisciplinary research from the universities of York, Salford and Sheffield. As a catalyst for the ensuing discussion the invited guest, Jonathan Eldredge, gave a comprehensive overview of the origins of the evidence-based librarianship, at least from a Stateside perspective. He explained how this paradigm had been floated as a concept through the pages of Hypothesis, the newsletter of the Research Section of the Medical Library Association1 and had subsequently generated enough interest to sustain a series of continuing education seminars held in conjunction with various events across North America. Debate at the Expert Seminar focused initially on the considerable implications that Evidence-based Librarianship has for the continuing education of practising librarians. This effect might be seen in several ways. Obviously librarians need to be equipped with the skills required to retrieve and appraise their own professional literature. Ironically, librarians are regarded as experts in searching for evidence to support the practice of other professionals but are very unlikely to do the same for their own practice. Encouragingly, however, some regions have considered adding the provision of Library and Information Service Abstracts (LISA) alongside the more traditional fare of medline and cinahl. For evidence-based librarianship truly to take hold, its impact needs to be more pervasive than simply generating a considerable additional training agenda. The nature and content of existing and proposed training programmes needs to be re-examined against the relevant evidence base. So, for example, a course on personnel management or project management would not just cover the ‘how to do it’ aspects so beloved of one-day NHS library training events but also would be grounded in the ‘what has been shown to work/not to work’. A third dimension to the continuing education mix relates to the methods used for delivering training. Evidence from the Cochrane Collaboration’s Effective Practice and Organization of Care Group suggests that conferences and didactic study days are not good ways of changing professionals’ practice. It would be ironic if, in teaching evidence skills or in inserting a backbone of evidence into the existing content of continuing education courses, the methods used to deliver such courses were non-evidence based! A further paradox identified by the Expert Seminar related to the skills required in order to conduct practice-based research. It was acknowledged that despite 8 or more years of including research in the curricula of departments of information studies this had not yet had a major impact on the quantity or quality of research studies. It was suggested that there may be a mismatch between the seniority of those librarians who are in a position to commission or publish research and the more junior staff who might possess the skills to conduct it. One possible solution for addressing this skills deficit would be through the development of mentoring schemes whereby those more experienced in research assist junior staff to bring locally conducted research to the point of publication. Incentives to publish are also required, in the form of protected time for turning internal reports into published accounts and by attaching greater kudos to such outputs. In addition there has to be recognition that, although the ultimate aim is to develop a profession with robustly critical attitudes and a rigorous evidence base, the ideal must not be allowed to become the enemy of the good. This requires acknowledgement that ‘good enough’ research or even failure stories could make a major contribution to the creation of an evidence-based climate or culture. There was much discussion of the nature and quality of research in health librarianship.No more than eight randomized controlled trials had been identified to date, supplemented by a catalogue of cohort studies as assembled by Jonathan Eldredge.2 In this connection three presentations on systematic reviews in librarianship delivered during an afternoon parallel session at the conference proved illuminating. The first of these, a systematic review of clinical librarianship by Catherine Beverley and Alison Winning, from the University of Sheffield, demonstrated that both quantitative and qualitative approaches to research synthesis will be required if we are truly to benefit from the lessons of the past. Alison Brettle, from the University of Salford, described how her ‘rapid review’ of end-user training had identified a paucity of studies carried out involving NHS practitioners (as opposed to healthcare students). This finding has the potential to inform future research priorities. Finally a presentation by Fiona Duggan, from the University of Northumbria, demonstrated through a qualitative systematic review of information provision associated with a major health incident that the wider evidence base might be equally important in informing our practice as that from our own more circumscribed vision of ‘information’. Of course, these three presentations yielded valuable insights in their specific areas of focus in addition to the more generalizable implications highlighted above. An important observation within the context of evidence-based practice relates to the characteristics of librarianship as a profession. It is unlikely that evidence for our training programmes, our service delivery, our management of services and staff and our marketing and publicity will be located within our professional literature alone. A broader and, one might say, more forgiving definition of evidence is required if we are to harness the not inconsiderable volume of studies from the education, management and business literature to benefit our specific perspective. For example the literature of end-user training will be located in computing, education or the broad social sciences and not just within the library and information sciences databases. Such a discussion of the nature of the evidence base leads naturally to consideration of current research priorities. It was felt that research in our profession tends to be more opportunistic than strategic. Priorities tend to be determined by the scope of calls for proposals rather than according to the identified needs of practitioners. Potential mechanisms for collecting intelligence on common themes that currently pre-occupy practitioners might involve analysis of proposals submitted to major funding programmes such as that from PPP healthcare. However, it is important to capture data on all aspects of the research (e.g. target population, research method, information domain etc.) rather than merely mirror the priorities of each particular funding programme. There is a particular need to commission studies that examine the impact of information provision or resources on patient care, as with the current Cochrane/Health Libraries Group Prize. In a modest, but nevertheless useful way, the second call for proposals for the Research in the Workplace Award, as initiated at the Conference, will make a further contribution to practitioner-based research. All the above make the fundamental assumption that practitioners are enlightened enough to want to practice evidence-based practice. Unfortunately, there is sufficient evidence from other fields to suggest that this might not be the case. Practitioners find it difficult to integrate research into their time-limited decision-making processes. Researchers are unlikely to acquiesce to the ‘hijacking’ of priorities by practitioners—after all, as one contributor stated ‘practitioners want answers while researchers want more questions’. Prioritization itself requires acknowledgement of the ‘important to know’ answers as well as those for the ‘difficult to know what to do’ situations. Different quantities of evidence will be available for these different situations and, in fact, each may require a different type of evidence. It must be acknowledged that barriers to the adoption of evidence-based practice are not insurmountable, regardless of how daunting they might initially seem. In fact a not inconsiderable body of literature examines how health professionals in general have successfully overcome such barriers as time, access, organizational culture etc. Some of the solutions discussed at the Evidence Based Librarianship Conference included synopses, syntheses and summaries. Practice-based guidelines have been used with some success in the context of healthcare and a Working Party of the Medical Library Association’s Evidence-based Librarianship Implementation Committee, which included UK representation, has specifically examined whether a guidelines-based approach might be transferable to health librarianship. Certainly, given the above concerns about the shortage of good-quality evidence, it is attractive to consider an approach where an initial definition of good practice, perhaps arrived at from consensus methods, is progressively overwritten, as and when new research evidence appears. Such guidelines of good practice, underpinned by a continually expanding evidence base, would provide a useful basis for communicating standards to entrants into the profession as well as ensuring consistency of approaches within, and between, health libraries. Ironically, indeed depressingly, such comparatively advanced techniques such as library accreditation employ standards that are not necessarily evidence based. One is reminded of the contrariwise evolution of quality assurance within the NHS as a whole whereby clinical audit, outlining what to count, preceded evidence-based practice which identified what really counts! What practical measures might we undertake to advance the pursuit of evidence-based librarianship at a local level? Ellen Crumley, a visiting delegate from Canada, described how she and her colleagues had set up an evidence-based journal club. When was the last time you and your colleagues sat down to discuss together the implications of a new piece of research for your library’s policies and procedures? Clearly we cannot bemoan the lack of evidence if we continue to underutilize the, albeit limited, evidence base that is already in existence. Also at a practical level, Anne Brice and myself have developed a one-day workshop, successfully delivered at the end of September to colleagues in the NHS in Wales, that provides an introduction to evidence-based librarianship. Together with a critical appraisal session, based on one of the cristal (Critical skills training in appraisal for librarians) appraisal checklists described previously in this column, the day includes introductions to research designs in a library context and examples of basic statistical concepts (entitled STAPL—Statistics for Petrified Librarians!). Not that this is intended as a commercial for such a programme of continuing education—opportunities to develop this workshop further are severely constrained by conflicting demands on our time but, more importantly, by the fact that such development work is currently done on an unpaid and voluntary basis. Whether evidence-based librarianship can really develop in the UK without either a funded programme of development or a major proponent or sponsor is extremely doubtful. Notwithstanding such a note of caution, it was certainly encouraging to see an initial groundswell of support for the inaugural Evidence Based Librarianship conference with just short of 140 delegates in attendance. If such enthusiasm can be harnessed, tapped and distilled then the future prospects of our profession becoming more evidence-based are healthier than we might otherwise think.