Business critical for health care Staff ratio policy

About the importance of knowledge specialists to health care

Healthcare is a knowledge industry. Enabling the workforce to access high quality evidence is fundamental to the delivery of high quality care.

HEE’s strategic library and knowledge service team works with NHS organisations across the regions to promote HEE’s vision:

“NHS bodies, their staff, learners, patients and the public use the right knowledge and evidence, at the right time, in the right place, enabling high quality decision-making, learning, research and innovation to achieve excellent healthcare and health improvement.”2

Currently there are 624 posts for qualified librarians in NHS trusts.3

Embedded roles

Our 21st century NHS requires proactive knowledge services as business-critical instruments of informed decision-making and innovation. These services call for a blend of expertise within knowledge services teams, encompassing:

  • embedded roles in clinical and management teams providing decision-ready information,
  • knowledge managers who mobilise corporate knowledge and staff ‘know-how’ to underpin strategy and operations

These emerging roles are pivotal in driving quality improvement and reducing inappropriate variation in care and cost.

Aligned to multidisciplinary teams, they search, and often synthesise and summarise information, to release the time of health professionals.

These roles foster a culture of using evidence from research and best practice and of utilising corporate knowledge and staff know-how to best advantage.

They facilitate knowledge sharing, enabling the workforce to develop skills to share their learning and spread innovation.

Librarians and knowledge specialists raise staff awareness of the impact of health literacy issues.

Finally, they play a role in equipping colleagues for the digital age, enabling NHS staff to develop digital skills.

Data on embedded roles

In 2018/19 47% (n=86) of NHS funded library and knowledge services had a dedicated post for either a clinical or outreach librarian, or other embedded role.

Demand for such roles is increasing. Between 2014 and 2019 the proportion of services which offer some kind of outreach, clinical or embedded element as part of their service has risen from 58% to 63%.4

Cross-referencing clinical librarian services with performance

The team of the Clinical Evidence Based Information Service (CEBIS) at University Hospitals Coventry and Warwickshire NHS Trust cross-referenced usage of CEBIS during 2017-18 with the subsequent CQC Inspections and ratings of ten specific services in April 2018. 5

The findings indicate that departments may benefit from optimising the expertise of clinical librarians:

  • 5 of the 7 services rated as ‘Good’ made significant use of CEBIS, requesting between 26 and 72 searches in the year.
  • 3 departments rated as ‘Requires improvement’ made limited use of CEBIS, requesting between 3 and 9 searches each

These data are not fully conclusive since two services rated ‘Good’ did not place any enquiries. Nevertheless, this case is illustrative of the positive benefits derived by healthcare services that optimise the expertise of clinical librarians.

The ratio of qualified knowledge services staff to healthcare staff at Coventry and Warwickshire is 1:1,082

Yielding a return on investment

A study conducted in the critical care unit at Wirral University Teaching Hospital NHS Foundation Trust found that an embedded clinical librarian role “helped staff to learn, develop and improve the quality of their care.

It nurtured an evidence-based culture across the department and generated a positive financial value from saving staff time, supporting their professional development and improving patient care.”

With academic research support from the University of Liverpool and the Centre for Health Economics and Medicines Evaluation, Bangor University, this recent study also reports that “for every £1 invested in the knowledge mobilisation model, a financial value of £1.18 to £3.03 was generated”.6