Supporting 'Best Research for Best Health'with best information

DOI: 10.1111/j.1471-1842.2009.00842.x

Supporting ‘Best Research for Best Health’ with best information Claire Beecroft*, Andrew Booth†, Mary Edmunds Otter‡, Christine Keen§ & Colin Lynch*, *Trent Research and Development Support Unit (Trent RDSU), †School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, ‡Trent Research and Development Support Unit (Trent RDSU), University of Leicester, §Trent Research and Development Support Unit (Trent RDSU), De Montfort University, Leicester, UK

Abstract Background: This article describes the potential role for National Health Service (NHS) libraries in supporting health research. The content is partly based on the proceedings of the ‘Best Information for Best Research for Best Health’ event at University of Leicester in November 2006. Objectives: With reference to the UK Department of Health’s Research and Development (R&D) strategy, Best Research for Best Health and the Cooksey Review of public funding of health research, the article seeks to identify areas where NHS library and information staff can become involved in supporting the research process. Methods: The authors examined the challenges and opportunities that these reports offer and looked at two areas where library and information services (LIS) staff can potentially expand their services-supporting researchers at every stage of the research process and transferring research into practice. Results: Staff in NHS libraries need to create an environment in which their role in the research process is recognized and valued. LIS staff can develop roles within the research process and thereby improve the robustness and validity of research outputs. Training and development of LIS staff is a key priority and can be taken forward despite the limitations of budgets and staffing levels. Conclusions: A proactive and assertive approach is needed to achieve a cultural shift within NHS library practice from supporting research from the outside, to being fully integrated within the research process.

Key Messages Implications for Practice d

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There are a few successful and yet isolated examples of good practice in providing significant, integrated information support to the research process. There is a need for more networking and exchange of innovation and service provision amongst information specialists regarding their support to research teams. Of equal concern is the development of advanced information skills and knowledge of the research process for the information specialist who frequently works in isolation.

Correspondence: Claire Beecroft, Trent Research and Development Support Unit (Trent RDSU), University of Sheffield, Sheffield S1 4DA, UK. E-mail: [email protected]

ª 2009 The authors Journal compilation ª 2009 Health Libraries Group. Health Information and Libraries Journal, 26, pp.307–315

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Implications for Policy d

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Best Research for Best Health6 offers an opportunity to consolidate and build upon the now-accepted role of the information professional in research support. Opportunities lie in support to systematic review projects, funding information services, training in information skills and outreach, but all of these require vigorous promotion. Planned developments include greater location of research support services at an NHS ‘patch level’ supported from academic units.

Introduction Research into health and health services is essential in tackling the increasing challenges that society faces from disease and ill health. In the UK there is much interest in ‘translational research’1 whereby research findings are used to influence practice and lead to economic growth and innovation. The UK government has sought to raise the level of Research and Development that takes place within the National Health Service (NHS)2 and to maximize return on investment and payback.3 Research programmes funded by the Department of Health, such as the NHS Health Technology Assessment and Service Delivery and Organization programmes4 seek to ensure that the policies, services and interventions provided by the NHS are based on the latest and most reliable evidence, as well as being responsive to the needs of the public.5 Firstly, this paper briefly examines the Best Research for Best Health6 Research and Development (R&D) strategy and the Cooksey Review.7 Then, based on the proceedings of the ‘Best Information for Best Research for Best Health’ event at University of Leicester in November 2006, it considers current provision of information and library services for the support of health research and finally concludes by highlighting opportunities and challenges resulting from this proposed reconfiguration of health research. Best Research for Best Health The health research strategy Best Research for Best Health6 ambitiously aspires to set ‘the direction that NHS research and development will take to ensure a vibrant, world-class environment for

conducting and using NHS health research’.8,9 The main components are: d a virtual national research faculty, including elite researchers; d a limited number of funded academic medical centres and technology platforms; d funding to move from historical flows to a system where money follows patient involvement; d expanding national research programmes and creating local funding schemes. Cooksey Review The Cooksey Review7 was commissioned by the Chancellor of the Exchequer in March 2006 to examine arrangements for public funding of health research in the UK.10 The Review was charged with considering health, science and economic objectives: d health objectives—ensuring research priorities are firmly grounded in the Government’s wider health objectives and that health research is rooted in, and a key priority for, the NHS; d science objectives—ensuring the continued delivery of world-class basic science. Funding should continue to be awarded on the basis of excellence across the full spectrum of health research, from basic to clinical and public health; d economic objectives—ensuring delivery of highquality translational health research to deliver real economic, as well as health benefits, from the UK’s science base. The review concludes that, although good progress has been made in some areas, further work is needed to ensure that publicly funded health research is carried out effectively and efficiently. It also identifies the need to facilitate rapid translation of research findings into health and economic benefits.


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Challenges and opportunities Since the original NHS R&D Information Systems Strategy, which endorsed the roles of the UK Cochrane Centre and the NHS Centre for Reviews and Dissemination,11 library and information services have played, and continue to play, an important role in the support, dissemination and application of health research.12 However, library leaders must be politically astute and exploit the new and changing environments outlined by documents such as the above.13 Best Research for Best Health6 reaffirms that knowledge and information management are central to production and consumption of research. The vision for knowledge management in the R&D Strategy recognizes the key role of three institutes: (i) the National Institute for Health Research (NIHR) to identify innovative ways of preventing, diagnosing and treating disease, (ii) the National Institute for Health and Clinical Excellence (NICE) to evaluate these innovations for clinical and cost-effectiveness and (iii) the NHS Institute for Innovation and Improvement to ensure that agreed innovations are implemented within the NHS. It is heartening to see at least one goal (Goal no. 4: Manage our knowledge resources) that holds a specific knowledge management focus. Several objectives within Goal no. 4 resonate with a health library audience; namely, to create a unified knowledge management system to meet the needs of stakeholders; to ensure research knowledge is made readily available to health professionals, researchers and the public; to facilitate application of research outcomes to improve health and delivery of services. Added to this is an ongoing commitment to use of the National Library for Health (NLH) as a channel for evidence as generated by the three Institutes described above. Further possibilities fall under such headings as Systems and Infrastructure: Proposed systems include the creation and co-ordination of Information Systems and provision of an Advice Service. Staff working in an information role already contribute to research and enquiry services both through the Research and Development Support Unit network and through

the RDInfo resource.14 Proposed developments thus constitute both a threat and an opportunity, depending on the extent to which existing provision is incorporated into proposed services. Proposals for infrastructure centre on research networks. These networks are to be co-ordinated by the UK Clinical Research Network Co-ordinating Centre through local centres. It is worth noting that invariably networks require servicing with an information function: ‘Need for a specific network co-ordination function that is financed, proactive and in control of the information, knowledge and/or incentives at the centre of a network’.15 The NIHR will continue to support a network of research support units. At the time of writing there is an invitation to tender for several ‘Research Design Services’ (RDS) eventually to replace the existing Research and Development Support Units (RDSUs), and to deliver a more sustained, intensive type of support to research groups rather than the capacity-building focus of the past. In summary, the authors feel that Best Research for Best Health6 is ‘upbeat’ for health librarians and information specialists but have anxieties regarding the focus on biomedical research, where the role of the research information specialist is more marginalized than in applied health services research and evidence synthesis. An additional challenge—and opportunity—is to ensure that NHS libraries fulfil their potential to support the development of research proposals, implementation of research and ensuring that NHS and social care staff are aware of research outcomes. NHS library and knowledge management support is essential in bridging the research into practice gap.16 The role of libraries in research in universities is well recognized and supported but there is a need for corresponding recognition of a related role for the library infrastructure existing within NHS organizations. Implications of the Cooksey Review7 for health librarians are less clearly discernible. There are potential opportunities from Recommendation 7.59, that is ‘to examine the effectiveness of employing a small number of full-time ‘‘Knowledge Transfer Champions’’ to disseminate the


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findings of health services research and facilitate early adoption of those findings into routine practice in the NHS’. If such a programme proves successful, it could likely extend to wider knowledge transfer functions within the NHS, such as dissemination and implementation of NICE guidelines. Creating the environment Information is fundamental to the research process but not all researchers may be aware of the information resources available to them or of the skills and knowledge that LIS staff can bring to bear on research projects. LIS staff need to be trained and developed to have confidence in their research skills and to value the contribution they can make to research. Traditionally, library and information personnel have supported research from ‘outside’ the core research team but, increasingly, they work from within. Both stances have their virtues; the former provides a unique ‘bird’s-eye’ view of the research process enabling them to identify key stages where information support is vital, the latter enables them to derive an in-depth knowledge of researcher needs.17,18 Roles Information specialists involved in supporting research, whether primary research or evidence syntheses such as systematic reviews19 emphasize the importance of a personal approach to promoting library and information services.20 Membership of local Research and Development committees provides an ideal opportunity for involvement with, and inclusion in, the research process. Ways to emphasize the role of information support include regular columns in a research newsletter or e-mail bulletin and ensuring that publicity is available via the R&D manager’s office. Links with R&D managers should be exploited to integrate training sessions on literature searching and critical appraisal into programmes provided by the research department. Another important aspect of promotion is the link libraries can provide to outside organizations such as local RDSUs or to independent medical statisticians.

While numerous roles exist by which an information specialist might work within the research process it will serve, for illustrative purposes, to focus on their role with regard to information support for systematic reviews.21,22 Systematic reviews are increasingly seen as providing the most reliable basis for conclusions about treatment effects.23 NHS librarians can provide support to such reviews in a similar manner to colleagues at institutions such as the NHS Centre for Reviews and Dissemination. High-quality searches, undertaken by an information professional, can increase the validity of the research through more comprehensive searches and more complete identification of papers. Systematic reviews provide an excellent opportunity for information professionals to become involved in research and to develop their skills. Research can also increase the visibility of the library service which is so essential in securing and maintaining funding. Library involvement can start from the research proposal. Library services can work with potential researchers seeking funding.24 This can include providing input to the protocol or providing research funding advice. As part of their service, NHS libraries can provide training on electronic resources such as MEDLINE and a document supply service. A specifically funded value-added service can augment such support by developing search strategies, hand searching journals and utilizing reference management software. Under such circumstances librarians contribute significantly to the review and this may even lead to their being acknowledged as an author. Skills Closely associated with roles assumed by information specialists supporting research are the skills required in supporting a research project. Typically, a research active department will need a librarian or information professional to provide input into research projects conducted within their department. They may contribute part of the salary and funds for additional training to enable the librarian to participate fully in the research process. Such an information specialist requires knowledge of the research process as a whole.



Specific information skills include a knowledge of advanced literature searching techniques and critical appraisal skills. However, it is important not to focus on purely ‘technical skills’. As a member of the research team, a librarian will also need to possess interview and communication skills to understand fully the research project being undertaken and the information needs of the other team members.20 Available courses for the librarian engaging with the research process may include 1-day courses in skills such as advanced literature searching, bibliographic referencing software and critical appraisal. However, the information specialist may also require an understanding of research skills in general which might be obtained by participating in a researcher training programme; for example, MScs in Health Services Research or Health Informatics. Support from networks of peers and mentors is becoming increasingly important. Mentors offer a safe environment within which a librarian can ask questions that might be considered ‘silly’ by the whole research team. Resources A persistent challenge is how to encourage a researcher to make the most of their local information resources. This is particularly acute for researchers on a new researcher training programme. Typically, these are 1-year training programmes in which students seek to gain an understanding of the research process and different methodologies. When undergoing such a programme, participants typically have to complete a project involving a small piece of research. A ‘typical’ candidate for such a course would be a midwife who has not done any research-type training since her midwifery course. Most libraries contribute to such programmes by running an induction course for their library. Others borrow their model for support from R&D more generally, utilizing the idea of clinic sessions or advice surgeries.25 These permit more individualized assessments of needs for resources, allowing in-depth coverage and intensive help with literature searching. Local NHS libraries need to ensure that local R&D departments are aware of services,

promoting them to R&D staff, senior managers, etcetera. Championing by R&D co-ordinators or researchers is critical. To be most effective, library staff members need to be trained in providing outreach services to those involved in research, analogous to the proactive endeavours required for clinical support or primary care services. Such an approach requires local computer access, good online resources and an integrated approach to the different types and formats of information available. Developing services for research support NHS library services have developed significantly over the last 10 years, both at a local level and through support from the National Library for Health. Whilst library staff provide training on a range of electronic resources, they may themselves need specialist support when it comes to supporting research. Specialist support services tend to be subject specific; for example, the Social Care Institute for Excellence (SCIE) exists to support those working in social care. Alternatively, other services provide methodological support, either across the research spectrum, as in the case of the RDSUs, or more specifically, as in the case of NHS Centre for Reviews and Dissemination (CRD), in providing expert help when conducting systematic reviews. Staff in specialist support services possess skills in supporting research, including knowledge of methodologies particularly around systematic reviews. The NHS CRD Enquiry Service is responsible for production of databases such as the Database of Reviews of Effects (DARE) and staff possess specialist skills in searching them. RDSU information services can provide links to specialists in areas such as systematic review methodology, statistics and health economics within a defined geographical area. Three particular opportunities exist for providing services for research support: d enquiry and general support services; d skills training; d outreach services. In each case, information professionals can assume an important role in being seen to support the role of other research colleagues.


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R&D enquiry and support services Funding services Although few libraries regularly engage in supporting researchers to find funding, offering such a service can provide added value within an existing service. In addition, such a service draws on skills and resources that are already available within a library. Finding funding is challenging as requesters’ expectations often exceed what is actually available and the funding opportunities that most closely match the request are seldom a ‘perfect fit’. Nevertheless, most researchers appreciate help with their search for financial support for their project. Most funding searches can be effectively completed using free, webbased databases and search engines (chiefly, www.rdfunding.org.uk). Usefully, this site enables users to create their own ‘newsletter’ from recently added or subject-specific funding opportunities, making it simple to produce ‘current awareness’ style mailshots about funding opportunities tailored to the specific needs of an organization, department or even individual. Another useful site is the Association of Medical Research Charities (http://www.amrc.org.uk) which lists most medical research charities in the UK with links to their websites. This site is easily browsed and is useful for a rapid survey of charities that might fund a particular project—especially when no obvious high-profile charities come to mind. R&D outreach An intended outcome from the Best Research for Best Health6 strategy is improved R&D funding to primary care. Specific barriers exist regarding the conduct of research in primary care and an information specialist must be aware of these26 and the specific opportunities that outreach services may provide. Research in social care is similarly fragmented with researchers working in a variety of different organizations. The SCIE aims to identify and review knowledge and research within the social care context,27 collating and disseminating it, to make knowledge and research more accessible by

producing knowledge reviews, systematic maps and research briefings.28 SCIE also produces Social Care Online, a database of information on social care at http://www.scie-socialcareonline.org.uk. The National Research Register for Social Care has recently been launched to document social care research at http://www.scie-socialcareonline. org.uk//researchRegister. R&D skills training R&D professional development is critical and the health information specialist can play a major role both within their own discipline and within the wider context of R&D continuing professional development (CPD).29 Workshops on accessing research evidence, such as those run by Health R&D Now in the North West, aim to give health care professionals skills to access research evidence and to judge when it is appropriate to take account of this in their practice. Traditionally, such training is delivered via face-to-face interaction. However, issues regarding face-to-face training include: the fact that it is a ‘one-off’ opportunity, there is limited time and groups can become too large. In addition, there is not yet conclusive evidence that such teaching methods are effective’.30 A MEDLINE tutorial developed by Grant and Brettle31 found a significant improvement in test scores between pre- and post-training. Developments in information technology (IT) mean that such tutorials are potentially easier to develop, manage and assess. Teaching of information skills for research presents particular challenges, including the inherent ‘nature’ of research where questions and responses become less and less binary. However, recent IT developments allow computers to be networked and open up possibilities for complex interactions between course participants. Possibilities from e-learning, in comparison with face-toface training sessions, include: d just-in-time access to materials available at point of need not point of delivery; d removal of geographical barriers; d recording of outcomes and application. In contrast potential problems include: d lack of face-to-face contact with fellow students and tutors;



necessity of IT skills; problems of access to IT; d problem of self-discipline and devoting dedicated time and not being seen as ‘on a training course’ by others. Further prospects are offered by an increasing array of social support software, the use of emerging Web 2.0 software, such as wikis and blogs, in e-learning.32 However, the technology should only be viewed as an enabler and a pedagogic background is useful in underpinning use of any technology. Information practitioners rarely have such a grounding in pedagogic theory.33 In particular, the use of blogs and wikis in e-learning must be incorporated into assessment so that student’s contribution is rewarded. Perhaps, therefore, a variety of forms of learning may prove most effective; hence, a current preference for so-called ‘blended’ learning.34 Clearly, delivery of information skills training to researchers in an e-learning environment must become a major priority. d d

Priorities for future development There is a significantly large and varied agenda for supporting research to command the attention of staff in health libraries, many of whom are already preoccupied with concerns of supporting the needs of education and clinical care. Information specialists are likely to need to learn about the new generation of Web 2.0 technologies—a need also present when supporting educational and clinical care related purposes.35 Areas traditionally outside the librarian’s remit, such as research governance and ethics, present an opportunity for an increased and specialist support role. Health librarians must keep up to date with developments at the National Institute for Health Research (http://www.nihr.ac.uk) and the accompanying implementation plans and progress. However, emphasis should continue on personal communication with local R&D managers and through involvement in increasing numbers of networks and partnerships. In attempting to support the R&D-related needs of others, health librarians will also need to target their own continuing professional development needs.

Conclusion Both the Cooksey Review7 and Best Research for Best Health6 describe a future for health research which will require at its heart a full range of highquality information services. As this article has demonstrated, there is a need for information support at every stage of the research process; including seeking funding and writing proposals and searching and critically appraising the literature. There is clearly a significant role for NHS library and information professionals to play here. Many skills required to support research, such as searching the literature, already exist in abundance in NHS libraries but these are not always valued and recognized. There are further skills, such as critical appraisal and the production of evidence digests, which need to be developed more fully in order to deliver the best possible service to researchers. By prioritizing, exploring training options at local RDSUs and cascading down training, it will be possible to raise skill levels. For small NHS libraries in particular, some operating with very few staff, it is essential that their managers assess existing services and prioritize new ones in order to develop a manageable way of extending support services to researchers without further overstretching budgets and workloads. Marketing of both existing and new services is also crucially important and developing links with local R&D departments is an essential part of this process. Such links not only provide a route for promotional activities but also the potential to access researchers and research networks and to establish the role of library and information staff as an indispensable support to all stages of the research process. While this may seem, at best, a long-term goal, there are numerous examples in the literature of library and information staff being included as authors on publications in recognition of their input into research projects. Making such recognition commonplace is an ambitious, yet achievable, aim. While all the above is both positive and exciting, it is important to remember that the Cooksey Review7 and Best Research for Best Health6 make no significant direct recommendations regarding the nature or resourcing of library and information support to NHS research. Pushing this agenda forward lies in the hands of NHS librarians


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themselves—without an assertive and proactive approach library and information staff will remain largely on the periphery of the research process and their contribution will remain unexploited and unrecognized. Acknowledgements We would like to acknowledge the speakers and presenters who participated in the ‘Best Information for Best Research for Best Health’ event at University of Leicester in November 2006 for inspiring this piece. No funding was received for this study and no conflict of interest was identified. References 1 Kerner, J. F. Knowledge translation versus knowledge integration: a ‘funder’s’ perspective. Journal of Continuing Education in the Health Professions 2006, 26, 72–80. 2 Buxton, M. & Hanney, S., Packwood, T., Roberts, S. & Youll, P. Assessing benefits from Department of Health and National Health Service Research and Development. Public Money and Management 2000, 20, 29–34. 3 Buxton, M. & Hanney, S. How can payback from health services research be assessed? Journal of Health Services Research and Policy 1996, 1, 35–43. 4 Allen, P., Peckham, S., Anderson, S. & Goodwin, N. Commissioning research that is used: the experience of the NHS Service Delivery and Organisation Research and Development Programme. Evidence and Policy 2007, 3, 119–34. 5 Dash, P., Gowman, N. & Traynor, M. Increasing the impact of health services research. British Medical Journal 2003, 327, 1339–41. 6 Department of Health. Best Research for Best Health: A New National Health Research Strategy. Available from: http://www.dh.gov.uk/assetRoot/04/12/71/52/04127152.pdf (accessed 22 January 2008). 7 Cooksey, D. A Review of UK Health Research Funding. London: Stationery Office, 2006. 8 Mayor, S. New funding to make UK ‘a world class environment for medical research’. British Medical Journal 2005, 331, 1359. 9 Evans, T. W. Best research for best health: a new national health research strategy. Clinical Medicine 2006, 6, 435–7. 10 Cole, A. Cooksey report recommends central coordinating body for research. British Medical Journal 2006, 333, 1239. 11 Sheldon, T. & Chalmers, I. The UK Cochrane Centre and the NHS Centre for Reviews and Dissemination: respective roles within the Information Systems Strategy of the NHS R&D Programme, co-ordination and principles underlying collaboration. Health Economics 1994, 3, 201–3.

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Received 20 February 2008; Accepted 1 December 2008
