Impact of increasing library usage
Several differences were identified in the usage of library services before and after the implementation of new services.
First, more respondents overall are using the library services in 2006 than in 2002. This is an important finding for administrators. These results support the continued funding of librarians and associated library services, as their use is increasing. However, like others,9 our study found that a large percentage of respondents still do not access the services available from the library. This finding suggests that more information is needed about the reasons why respondents are not accessing the library for their information needs.
Second, the awareness of and use of three selected library and information services have increased for respondents between 2002 and 2006. In order to get health-care providers to access and use information in clinical decision making, they need to know of the existence of such information and services. This finding confirms that our current marketing strategies are working, but there is still room for improvement, if we can determine what other factors affect a respondent's decision to use the library to meet their information needs. For example, in the comments, respondents indicated that the demands of their clinical schedule limited their ability to search for information, but we do not know how many of them are aware that the librarians can do the searching for them.
Third, like others,9 our study found that most respondents obtain information from sources other than the library. However, the use of the library to obtain information is increasing and the use of the Internet to obtain information is decreasing for both respondent groups. It was found that physicians chose to access the services at the University of Saskatchewan Health Sciences Library rather than the SHR Medical Library, but it is positive to learn that physicians are accessing an established library system instead of continuing to obtain information unassisted from the Internet. Although the number of reputable open and free publication sites on the Internet is increasing, the inherent value in having a librarian help to find the best overall sources of information cannot be overlooked.
These findings and impacts indicate that the trend for all respondent groups to use SHR Medical Library to meet their information needs is increasing. Given further time and expanded marketing of available SHR Medical Library services, it is likely that the SHR Medical Library will overtake the Internet as the preferred information source for health-care providers in our organization.
Impact of increasing information needs
Respondents in both 2002 and 2006 were asked to identify how often they required information to carry out their job duties. To assess for changes, detailed analysis was completed comparing the results from 2002 and 2006 using different levels of information needs. Overall, the information needs of respondents are increasing.
A cross tabulation of the respondents’ information needs and work departments was completed in order to identify specific departments whose respondents reported frequent information needs so that targeted marketing strategies could be developed. Medical residents all have frequent information needs regardless of department; physicians from medicine and surgery have frequent information needs; and employees in pharmacy, public health, nursing development and mental health and addictions services have the most frequent information needs.
However, when the results of this analysis were presented to the leaders of the departments, the leaders felt that it is not the frequency of information needs that is important. Rather, the leaders felt that their staff need to have access to relevant and accurate information in a timely and efficient manner, no matter how frequently or infrequently they require it. Comparing frequencies of requiring information may not be the most effective way to establish context for determining the impact of providing information, as it was found that the frequency of requiring information had no further impact on how the information was subsequently used to impact clinical practice. The challenge for the library now is to determine how they are best going to meet these increasing needs for information.
Impact of providing information
To further assess the impact of the information received from the medical library, respondents were also asked to indicate both general and specific reasons for needing information from the library. The rationale for including two separate questions was to differentiate between respondents requiring information to decide upon a course of clinical actions that directly impact patient care, and respondents requiring information as part of the ongoing learning processes of providers that indirectly impact patient care through the improvement of overall knowledge.
Not surprisingly, respondents indicated that patient management is the most frequent general reason they require information. Given our rationale, we think that our findings are similar to those of others.13,15 Cuddy15 found that patient care was the most frequent use of information. Likewise, King13 found that the majority of respondents in his survey changed how they handled (or would handle) a clinical case based on the information they received from the library. It is possible that our respondents who are using the information for patient/client management could be using the information to make changes in how they handle clinical cases.
In order to further delineate the uses and impacts of information received from the medical library, we adapted the question used by Marshall,14 who asked respondents to indicate specifically how they had used the last piece of information that they had requested. Response choices in that question included very specific clinical actions, such as changing tests, X-rays, prescriptions and hospital admissions. Response choices also included more general uses and impacts of information, such as patient advice, determining a treatment plan and finding out about a certain condition.
Marshall14 found that the top reasons for needing information were patient advice, change in tests, change in prescriptions and change in diagnosis. These findings are directly clinical in nature, and using information for these purposes can directly affect patient care. In contrast, our survey found that physicians need information to determine a treatment plan, find out about a condition and confirm a diagnosis, and employees need information to find out about a condition, determine a treatment plan and provide patient advice. These findings, while having the potential to impact outcomes such as patient care and cost, are more intangible.
The only way in which our respondents’ choices matched the results found by Marshall14 was that our respondents needed information for patient advice. One other result was close to being similar. Marshall's14 respondents indicated that they used information to change a diagnosis, and our respondents indicated that they used information to confirm a diagnosis. Although an argument can be made to suggest that changing a diagnosis and confirming a diagnosis are similar actions, we do not believe that they are. We believe that there is a difference between using acquired information to completely change a diagnosis, and thereby possibly change treatment, and using acquired information to confirm a suspicion, and thereby continue with treatment.
There are several possible explanations for these differences. First, the differences could be as a result of the different populations being sampled. Marshall14 only sampled physicians, whereas our sample was a cross section of all health-care providers. As providers who possess a great deal of knowledge, physicians might be more concerned about patient advice, tests, prescriptions and diagnosis, whereas a sample of all health-care providers could be more interested in using the information to improve their general level of clinical care.
Second, the differences could be a measure of the health-care systems in which the studies were conducted. The study by Marshall was conducted in the USA, where privatized hospitals and health management organizations tend to put much more emphasis on how much the cost of care factors in to the overall quality of care for the patients. Our study was conducted in Canada, where the health-care system is more focused on improving the overall level of care for all patients across the entire system, and the cost impact of providing high-quality care, while also important, is a secondary concern. Given these differences in systems, it stands to reason that physicians in Marshall's study14 used the information to change clinical actions that would have a direct impact on patient care, while respondents in our study used the information to improve the level of patient care overall through the increase in knowledge about medical conditions and treatment plans.
Third, the study conducted by Marshall14 is not a recent one and, in the time since the study was conducted, there may have been a general shift regarding the impact of information received from health libraries.16–19 For example, Abels and colleagues16 have developed a taxonomy of ways in which libraries contribute to the organizational goals of hospitals and academic health centres. The taxonomy includes the specific impacts of care outlined by Marshall,14 but it also includes indirect aspects of patient care, and the more intangible concepts that large health-care organizations are concerned with, such as accreditation standards, improving productivity and increasing staff satisfaction. The finding that our respondents most often use information received from the library to determine treatment plans and find out about medical conditions is closer to the intangible impacts outlined by Abels et al.16 than they are to the more specific cost impacts found by Marshall.
This finding indicates that the assumption on which we measure the impact of providing information to health-care providers may be faulty. To date, the definition and importance of determining the impact of information provided by the library has been related to measuring the existence of differences in patient care, such as outcomes and costs, as a result of the information. Administrators today require proof that their investment in the information service is not going to waste. The assumption is that if the information is used to make a situation better for a patient, then the information was worthwhile and, therefore, funding should be made available to continue to provide the information service.
While more study is needed to determine the tangible impacts of information provided to health-care providers in our organization, we also believe that the emerging areas outlined in the taxonomy of Abels et al.16 may be a better fit with our specific organizational goals. As a result, more research is needed to determine how our library service can provide information so that both tangible and intangible aspects of care are impacted by the provision of information to health-care providers.