Building partnerships in a complex academic research environment

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1.University of North Carolina at Chapel Hill, Health Sciences Library, 335 South Columbia, Chapel Hill, NC 27599, USA. E-mail: nanditam@unc.edu 2.Community Engagement, AHEC, and Outreach Services, Health Sciences Library 3.Clinical, Academic, and Research Engagement, Health Sciences Library 4.Information Access and Discovery, Health Sciences Library

[Abstract]Change in the information landscape has afforded librarians an opportunity to actively seek new skills, knowledge, and opportunities in order to effectively integrate expertise at the point of need; in particular, librarians have shifted from being information providers to embedded information creators, integrators, and innovators. Our ability to capitalize on the strengths of our specific institutional environments and respond to information needs is ever more important if we are to remain central to the work of our academic enterprise. This article describes how the University of North Carolina at Chapel Hill's Health Sciences Library (HSL) has sought opportunities and established successful partnerships that integrate library expertise aligning with the two core strategies of Carolina's new strategic framework Blueprint for Next: Of the Public, For the Public, and Innovation Made Fundamental. These efforts have resulted in initiatives that improve access to quality health care and health care information for North Carolinians, accelerate the campus' research enterprise, and demonstrate the importance of evidence-based care at UNC and globally. By understanding and identifying the needs of our various stakeholders, we have been able to progress with our understanding of what key problems need to be solved, what interventions need to be developed, and in what ways librarians can integrate expertise around information synthesis and critical thinking so that we are seen as valued partners in our complex academic environment.

[Key words]Partnership; Clinical; Academic librarianship; Research; Collaboration; Innovation; Health sciences

Across domains, libraries have seen a dramatic shift in how information is consumed and created which has fostered an environment in which libraries have taken a continuous improvement approach to developing programs and services. Constant change in the new information landscape has afforded librarians an opportunity to actively seek new skills, knowledge, and opportunities in order to effectively integrate expertise at the point of need. To be seen as a valued and indispensable partner, librarians have shifted from being information providers to embedded information creators, integrators, and innovators. Our ability to capitalize on the strengths of our specific institutional environments and respond to information needs is ever more important if we are to remain central to the work of our academic enterprise. It is evident that at the University of North Carolina at Chapel Hill (UNC-CH), our ability to build partnerships in a complex research environment is a boon for our library and campus community. The UNC-CH Library system comprises 9 libraries, has 290 FTE, and is part of a highly ranked research-intensive campus consisting of several top-rated programs, and a research enterprise in which more than 1 billion dollars of sponsored research has been conducted in the last year[1]. The Health Sciences Library[2](HSL) is a central hub and connector to our 5 health affairs schools (including Dentistry, Medicine, Nursing, Pharmacy, and Public Health) and medical center.

Building partnerships across our campus and our state has been a key part of our vision to meet the information needs of Carolina. The HSL has built connections with many schools and programs including (but not limited to) the North Carolina Area Health Education Centers (AHEC), Institute for Global Health & Infectious Diseases (IGHID), the North Carolina Translational & Clinical Sciences Institute (NC TraCS), and Carolina Health Informatics Program (CHIP). To enable strategic integration of library expertise, the HSL has followed Carolina′s development of a new strategic framework, Blueprint For Next[3], which is an essential roadmap that provides guidance on how our library can address key components vital to our institutional mission. Two core strategies for addressing this framework include: Of the Public, For the Public, and Innovation Made Fundamental. Below are examples of how the HSL strives to address components of the Blueprint For Next, all the while keeping partnership cultivation and library integration at the forefront.

Of the Public, For the Public

The HSL supports this strategic objective in three ways. First, the HSL has partnered with the North Carolina Area Health Education Centers Program[4](AHEC) to improve access to quality health care for the people of North Carolina through community-based health workforce education and support for health care practitioners′ life-long learning and continued professional development. Second, HSL has partnered with the UNC Hospitals and clinicians around the state to support improved quality of care and patient engagement through teaching and applying health literacy principles to patient education activities. Third, with public libraries, high schools and community organizations in order to help individuals and caregivers better manage their health and health care.

Since the establishment of the NC AHEC program in 1972, AHEC and HSL have worked together to establish health sciences libraries in each of the nine AHEC regions of the state. The regional AHEC libraries provide library services including reference consultations, expert literature searches, and access to clinical decision-making tools for health care providers, with a focus on service to rural and under-served communities.

In 2000, HSL created the AHEC Digital Library (ADL) to provide access to core electronic books, journals, and databases for small, medium, and large community hospitals so that clinicians from all types of communities would have access to resources comparable to those found in urban and academic medical center libraries. Today the ADL hospital consortium provides a core collection to 55 community hospitals ranging in size from the 25-bed critical access hospital to the large 1,000 bed urban hospital. The members of the consortium, who share the cost of the digital library based on hospital size, have access to a collection at approximately half the cost they would have to pay if they bought the resources independently. Librarians at HSL manage this digital collection and coordinate with the network of AHEC librarians who provide expert literature searching for health professionals and students throughout the state.

Through AHEC, health affairs students learn clinical skills in community-based clinical rotations, which provide students varied clinical experiences with diverse clientele and provide important health services to the people of North Carolina. To assure that community-based faculty can provide the same educational experience as campus-based faculty, community faculty are given UNC affiliated faculty status in order to access the resources of the University Libraries. In 2016-2017, there were close to 3,000 community-based faculty located in almost every one of North Carolina′s 100 counties. The majority of UNC′s Health Affairs 5,355 students will receive instruction by these community-based faculty during an internship or clinical rotation.

In addition to Libraries and workforce education, HSL has integrated with AHEC partners in order to provide several important value-added library services. These services include: 1) creating subject guides on important statewide initiatives, like treating the opioid addiction crisis in North Carolina; 2) providing knowledge management services for the AHEC Practice Support Consulting group who consult with 1,000 NC primary care practices on quality improvements in patient care; and 3) collating resources to support continuing professional development through monthly nursing research journal clubs in community hospitals, and to support recertification requirements for Board certified physicians. AHEC and HSL partner to lead the strategic planning for the AHEC Information and Library Network to determine library information, resource, and technology needs of the state′s workforce, and to assess how the partnership can make a difference in health care.

The HSL also supports the university′s strategic vision for services to the public by contributing to improving patient care, health literacy, and patient engagement. HSL librarians provide assistance and instruction to health care providers who are writing and delivering health information in plain, easy to understand language. HSL librarians partner with public libraries and community groups that are engaged in helping individuals and caregivers to understand and manage their health.

The NC Health Info website, created at HSL, serves as a 24/7 portal for locating trusted health information important to North Carolinians. The website′s "Ask-A-Librarian" feature encourages anyone to request a one-on-one consultation with a librarian. NC Health Info aims to assist people in managing their health care in order to become better informed health information consumers. It enables easy access to reliable online health information in English and Spanish; the ability to access NC specific resources such as those related to state agencies or purchasing health care insurance; and finding digital and social media resources like local and online support groups, mobile apps, and tools. A network of skilled volunteer editors from around the state help to update relevant health information topics on NC Health Info.

In summary, through our partnerships with NC AHEC and NC Health Info, we provide services to community hospitals, community preceptors, and patient education/health literacy. HSL Librarians are providing statewide outreach to the students and faculty learning to provide the highest quality clinical care; to practicing clinicians who want to provide the clearest patient communications; and to anyone seeking to learn about how to manage their health.

Innovation Made Fundamental

The HSL addresses this second pillar of the strategic framework with multiple initiatives to accelerate research. The HSL partners with a variety of groups within the extensive research enterprise at the university. Partnerships exist with systematic review and similar teams needing expert skills for searching, evaluation, and management of the literature; with research departments to fund the acquisition of a campus-wide tool that helps researchers conduct and document systematic reviews and other extensive searches; with researchers who include support for librarian salaries to add their expertise to their research team; and with departments assessing the impact of their research. Some examples of how the library has evolved to support these partnerships are given here.

The Health Sciences Library partners in the research process by providing informationist and data management consultations, events, training, guidance, tools, and referrals. The Research Hub @ HSL, one of three research hub locations provided by the University Libraries, connects Carolina researchers at every stage of the research process with the experts and tools they need to help make their research more connected and collaborative. Two of the most recent foci of the Hub are in measuring research impact and digital health.

The library created a new team for impact measurement and visualization (IMV) within its Health Technology & Informatics (HTI) unit, to address questions departments and research groups were asking: To what extent are specific programs publishing in key research areas? With whom are we collaborating internally or externally? Which institutions are publishing in key research areas of interest? What are trends in publishing over time? What is the density of research influence as based on citation metrics? Some of the project partners working with the library on these questions include the Eshelman School of Pharmacy, the Lineberger Comprehensive Cancer Center, UNC Global, the Kenan-Flagler School of Business, and the UNC School of Education.

To ensure the library remains at the forefront of new and innovative projects, the library′s team in HTI has spent time connecting digital health experts around campus with each other and with industry, based on areas of interest and research opportunities. In addition, through a collaborative innovation award with the School of Medicine, we launched the program, Carolina Digital Health Research Initiative (CaDHRI), which promotes innovative use of digital health solutions to solve pressing patient-centered health problems. To support the initiative, the library has launched a collection of digital health devices available for checkout. The HTI team also provides consultations on how digital devices can be utilized for research inquiries, development of health care interventions, connecting interested parties from health care, industry, and research arenas that wish to develop a digital health intervention, and best practices for incorporating digital devices into both teaching and research opportunities. We have also hosted twelve lectures related to digital health, and have a biweekly newsletter with more than 800 subscribers. The library also held its first Digital Health Symposium on February 23rd, 2018, with speakers including students, researchers, library staff, and off campus representatives from industry, government, and non-profit organizations. While this is a new area for the library, we hope to continue collaborating with the various schools on our campus that have an interest in digital health and pursue additional opportunities to connect industry partners with campus collaborators to enhance health care interventions and utilization around consumer level technologies.

The Hub also provides instruction on equipment and software use so teams can apply new digital research methods to their work. The Research Hub @ HSL offers a variety of software in the following categories: Data Visualization and Molecular & Chemical Modeling tools, Data Cleaning tools, GIS/Mapping tools, Programing Applications, and Statistical Applications. The Research Hub′s Collaboration Center space offers video and web conferencing software including Polycom Real Presence, Skype, and Google Hangouts. The services and activities provided through the Research Hubs lead to new partnerships.

Related to data management, the library is taking a consortial approach to explore a novel way of handling at risk genomics data across campus. This has led the library to reach out to become part of the Data Catalog Collaboration with New York University, University of Pittsburgh, Duke University, University of Virginia, and University of Maryland, and successfully apply for a 2017-18 National Network of Libraries of Medicine Data Catalog Award. The library staff will use a model and open source coding developed at NYU to establish a genomics data catalog for the university. While the catalog system has been used for other types of data, our library is contributing its expertise to this multi-institutional research collaboration in the area of genomics and reaching out to potential partners, for example, the Lineberger Comprehensive Cancer Center and the Department of Genetics.

Additionally, HSL has formed a strong partnership is with the interdisciplinary Carolina Health Informatics Program[5](CHIP), which offers certificate, masters, and doctoral programs through the UNC School of Information and Library Science (SILS). Faculty come from the library, information science, all five health affairs schools, and computer science. The library houses the CHIP Collaboratory, spaces where scientists, clinicians, and students work together on informatics research initiatives. HSL also hosts a weekly seminar taught by a librarian from the HTI unit, and cross-campus forums for health informatics researchers, among other joint events. A fairly new collaboration, the library and CHIP are exploring opportunities to seek grant funding together and to integrate librarians further in informatics research and instruction.

Another way in which the library carries out Innovation Made Fundamental occurs with partnerships in the clinical care environment of the UNC Hospitals. Librarians are embedded in various departments as an innovative way to provide informatics expertise to students and practitioners and to demonstrate the importance of evidence-based care at UNC. As one clinician noted:

"The upper GI surgical service has a weekly case conference in which we review the history and physicals for all of our planned surgical procedures…We discuss decision making, and the data driving the process. It is invaluable to have a clinical librarian present to identify knowledge gaps and perform an in depth review of the current literature. Our librarians…do an outstanding job sorting through the vast amount of literature to identify recent and pertinent studies that assist in the education of our students, residents, and staff alike. [The librarian] returns with a group email including a succinct but thorough data-driven answer to our clinical questions…[The librarian] is an integral member of our clinical care team…I find this unique relationship to be a significant part of the excellent clinical care we provide here at UNC."

In addition to serving our state, we have developed relationships in the global arena by collaborating with the Institute for Global Health & Infectious Diseases′ (IGHID) UNC sites which include programs in China, Malawi, Nicaragua, Vietnam, and Zambia. Librarian integration in these sites have included partnering on systematic reviews, building a physical library collection in Malawi, and assisting with the curation and dissemination of information resources to meet project site specific needs. As the library would like to address additional opportunities around information synthesis and utilizations, we plan on enhancing access to information resources (both publicly available and locally curated materials) by leading efforts to design and implement an eGranary in our project site in Malawi. By pursuing this pilot project, it will provide the library an opportunity to see how information is utilized in the clinical environment and identify additional information, instructional, or technological needs prior to further design and implementation elsewhere. A site wide needs assessment will also be led by the HSL to ascertain any gaps around information access, instructional needs, and technological utilization particular to each project location. Over time our role in the global arena has grown from the development of a physical library collection to identifying core resources to be integrated for our diverse populations. Our role in both the local, regional, and international landscape cannot be understated as we have become embedded in the work of our project partners in ways that are seamless and seen as value-added.

To effectively engage on campus and contribute to the mission of our University, it has been imperative that the library proactively build partnerships across our campus. By understanding and identifying the needs of our various stakeholders, we have been able to progress with our understanding of what key problems need to be solved, what interventions need to be developed, and in what ways librarians can integrate expertise around information synthesis and critical thinking so that we are seen as valued partners in our academic enterprise. By participating on curriculum committees, establishing new services to help demonstrate impact, contributing to systematic reviews, providing outreach to our health care providers and community, and ensuring access to reliable information in the global arena, our library has been able to thrive and remain relevant to our campus community.