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Experience shows that a thorough reference interview and a carefully thought out search strategy more often than not result in an effective search. Within evidence-based practice, clinicians have developed a set of structured questions, known as PICO (patient and/or problem, intervention, comparison intervention, and clinical outcomes1). This mnemonic is now commonly used by health information professionals when searching for the best current evidence. However, the need for well-structured search strategies is not restricted to clinical queries; health librarians are also increasingly being called on to provide management-related bibliographic references which also require well-planned search strategies. The problem is that the PICO formula is not appropriate for this type of enquiry. This Brief Communication suggests an alternative to PICO as a framework to help when searching for health and social care management information. In July 2000, a request for training in medical terminology appeared on the lis-medical e-mail list. Coincidentally, this followed a training session on searching the HMIC database which was held at a London Hospital. We concluded that this call presented an ideal opportunity to develop our own training session into a seminar on health and social care management terminology. The aim was to concentrate particularly on terms differing from those in the clinical world. Unlike medical terminology which, on the whole, is more stable, health policy/management terminology is constantly changing and full of buzz words. It is also often considered to be ‘softer’ than clinical terminology. Searching for information using this terminology requires a shift in approach. The answers to the enquirer’s questions may not be as rigorously scientific, quantitative or systematic as those retrieved in clinical searches. While PICO can assist to a certain extent, it will not cover the full range of questions necessary to tease out all the elements of a management- or policy-related enquiry. We therefore looked for an alternative aid and came up with the mnemonic CLIP in an attempt to bring a systematic approach to a potentially non-systematic topic. The components of CLIP were: Client group—at whom is the service aimed? For example, older people, black and ethnic minority groups, people with a specific condition. Location—where is the service sited? Is it in primary care, secondary care, across the entire NHS? Improvement or Information or Innovation—what does your user want to find out? For example, are they looking for a model of good practice, how to improve a service, how a service is organized? Professionals—who is involved in providing/improving the service? For example, doctors, nurses, lay people, social services. We recognized that, as with PICO and other search strategies, not all of the elements in CLIP would be relevant to every search; however, we calculated that each should be considered at the start. CLIP was introduced at the seminar run at the King’s Fund in February 2001. This was further developed both for a poster session, with accompanying ‘giveaway’ postcards at the Evidence-based Librarianship (EBL) conference held in Sheffield, U.K., in September 2001, and for a repeat of the terminology seminar later that same month. On both occasions it generated much interest and feedback from the librarians attending these events indicated that CLIP was useful in conceptualizing literature searches. In developing CLIP, we were concerned that the ‘I’ component of the mnemonic did not work as well as the other parts. This was because it held three concepts within one, and was thus not easily memorable. Originally, we had felt that it was important to include the three words in one concept and wanted to emphasize the need, when formulating a search, to consider the different purposes for which the information might be used. Depending on which of the ‘I’s relate to the question, the structure of the search would be different. A colleague, on being asked to provide feedback on CLIP, reinforced our reservations on the ‘I’ component. He also made some other useful suggestions which helped us remodel our mnemonic and so, CLIP evolved into ECLIPSE. The original Client Group, Location and Professionals elements of CLIP were retained in the new tool, ECLIPSE. An ‘E’ for Expectation was then placed at the beginning to encapsulate the essential ideas of ‘Improvement’, ‘Innovation’ or ‘Information’. The ‘I’ was changed to represent ‘Impact’ and ‘SErvice’ was added at the end. ‘Impact’ can be seen as similar to ‘outcomes’ in the PICO model. The ‘SErvice’ part of ECLIPSE draws out something which we had hoped was underlying every management or policy search. In the original version of the tool, we had assumed that the idea of a service would always be somewhere in the background; it did not need to be spelled out. With hindsight we have realized that it is helpful to reiterate that a particular service is involved. For some searches this will be essential. The model now reads: Expectation—what does the search requester want the information for (the original ‘I’s)? Client Group. Location. Impact—what is the change in the service, if any, which is being looked for? What would constitute success? How is this being measured? Professionals. Service—for which service are you looking for information? For example, outpatient services, nurse-led clinics, intermediate care. How does ECLIPSE work in practice? What an enquirer claims to want isn’t always necessarily what he or she in fact needs. This is no different for the enquirers contacting the King’s Fund Library. A typical question we receive might be ‘What have you got on rehabilitation?’ An immediate and simplistic response might be: ‘several hundred references’ (!). Using ECLIPSE both as part of the reference interview and in the formulation of the search strategy, the hits for this question can be whittled down. The enquirer may then receive a more manageable number of references that closely meet his or her needs. What have you got on rehabilitation? Expectation. I’m looking to improve the discharge procedure from the hospital to the community where rehabilitation will continue. What have other people done? Client group. People with head injuries. Location. Community. Impact. Improved continuity of care; patient satisfaction increased; greater sense of communication between professionals. Professionals. Hospital nurses, community staff, social services. Service. Community rehabilitation service. There is a lack of continuity of care in my area for people with head injuries who are discharged from hospital to the community rehabilitation service. I would like to improve the discharge procedure to avoid this problem. The service involves both community health staff and social services. Has anyone else experienced similar problems and how have they overcome them? Use of the mnemonic CLIP as a search aid evolved from the use of certain questions which we, as experienced health policy librarians, found we automatically asked in a reference interview. We started using it at the beginning of 2001 and by the end of the same year, had further developed the tecnhnique into ECLIPSE. Since its inception, our use of CLIP/ECLIPSE has focused our minds more systematically on our reference interview questions. It has also been of great benefit when training new staff. It is our hope that the wider health information community will also find it a useful model when searching for health and social care management information. It is important that it continues to evolve and perhaps, like PICO, comes into everyday use. We welcome all feedback on its usefulness in order to make certain that it meets the needs of fellow health information professionals. We would like to thank Andrew Booth for his suggestions and encouragement in developing the ECLIPSE model.
Wildridge et al. (Sat,) studied this question.