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Documentary Practices of Hospital Librarians in Evidence-based Medicine: the Example of Health Technology Assessment in Swedish Healthcare
Linnaeus University, Faculty of Arts and Humanities, Department of Cultural Sciences.
Linnaeus University, Faculty of Arts and Humanities, Department of Cultural Sciences.ORCID iD: 0000-0002-6184-6603
2021 (English)In: Proceedings from the Document Academy, ISSN 2473-215X, Vol. 8, no 2, p. 1-22, article id 12Article in journal (Refereed) Published
Abstract [en]

In times of health crises, we rely upon the knowledge and skills of our highly specialized modern healthcare. But what are the tools and principles that healthcare relies on to make informed decisions about courses of treatments? In this paper, we will attend to documentary practices of hospital librarians in Health Technology Assessment (HTA), an example of how the evidence-based movement is enacted in modern healthcare.

Since resources for health care are limited, there is widespread political support for making rational choices based on evidence. Use of evidence is today a key element in health care at policy, administrative, and clinical levels (Banta & Jonsson, 2009). The evidence-based movement originates from the notion of evidence-based medicine (EBM) but can also be related to the broader movement evidence-based healthcare (Chaturvedi, 2017). The most reliable evidence is generally considered to be systematic reviews of randomized controlled trials, minimizing the risk of bias and allowing for causal explanations of interventions. In this way, EBM is grounded in a natural science-oriented epistemology directed towards quantitative and predictive studies (cf. Sundin, Limberg & Lundh, 2008). Arguably, (medical) librarianship and EBM share a common goal: the application of the best scientific research in the process of providing efficient and safe medical care to patients (Eldredge, 2000). In line with the development of the EBM paradigm, systematicreviews are also ascribed a high level of evidence within the field of LIS (Eldredge, 2000). Notably, systematic reviews connect to a core skill of librarians and related professions: literature searching. Overall, systematic reviews are designed to reduce bias and to synthesize scientific evidence to answer specific research questions (Higgins & Green, 2011).

HTA, a practice centered on synthesizing evidence through systematic reviews, originates from the US Office of Technology Assessment that produced a first report on the matter in the late 1970’s. In the late 1980’s, HTA spread to Sweden and then to other European, Latin American and Asian countries (Banta & Jonsson, 2009). Several international actors such as The World Bank, WHO, and the EU have been active in the field of HTA, providing funding, coordination and making HTA more visible (Banta & Jonsson, 2009). In Sweden, the independent national authority Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU) is tasked by the government to provide assessments of healthcare and social services covering both medical, economical, ethical and social aspects. SBU, one of the oldest HTA-organisations in the world, produces systematic reviews and has developed a review method outlined in the SBU Handbook (SBU, 2020). The local HTA-units studied in this paper follow the procedures and methods described in the SBU Handbook.

Major work tasks for hospital librarians include supporting healthcare staff in their information seeking and providing healthcare staff with relevant information (Lewis et al, 2011). Increasingly, such work is done in collaboration between clinicians, researchers and librarians (Hallam et al, 2010), and HTA-teams with medical doctors, librarians and other specialists can be seen as examples of this trend. In this paper we focus on hospital librarians – a profession often overlooked, but still crucial for many of the documentary practices associated with EBM in general, and HTA in particular. As part of an ongoing research project focusing on information work of hospital librarians in different professional practices, this paper is guided by the research question: how are documentary practices associated with HTA-reports shaped by, and shaping, the work of hospital librarians?

In this study we apply the concept of documentary practices, understood as activities surrounding various types of documents (Pilerot & Maurin Söderholm, 2019). Our research interest is based on the role and function of documents in practices, and how documents create and construct social practices (Brown & Duguid, 1996). The way we view documentary practices departs both from practice theory (see for example Nicolini, 2013; Reckwitz, 2002), as well as from critical document theory (Lund, 2009). From a practice theoretical approach all human action is regarded as practices which comprise a set of routinized social activities, norms and artefacts as well as a common idea on how the world is constituted (Reckwitz, 2002; Talja & McKenzie, 2007). Lund (2009) with the support of Smith (2005) suggests a critical view on documents and how they provide a pattern for upholding structures of power, where a focus on the content of the documents has transformed into a focus on documents as underpinning social life. According to Brown & Duguid (1996), documents structure practices and also contribute to bring together social activities, relations and interactions within practices, in the same way as social practices may influence documents. Documents are resources for negotiating the meaning of practices: the role of documents in practices is captured through the notion of "the social life of documents" (Brown & Duguid, 1996).

The empirical material of the ongoing research project includes nine in-depth interviews with hospital librarians and five observations of hospital librarians indifferent work situations, including search instructions and HTA-meetings, at three different hospital libraries in Sweden during January - February 2020. In this paper, we focus on the HTA-process and how documents like the HTA-report and the SBU Handbook interact with documentary practices. To provide additional empirical depth, supplementary interviews and observations from a fourth hospital library are planned.

Preliminary findings show how the HTA-process at two HTA-units entails five main categories of documentary practices: 1) initial searching when a clinicalquestion is submitted; 2) negotiating a literature search strategy in the HTA-team; 3) conducting the main literature searches; 4) making a selection; and 5) documenting the search process. The SBU Handbook contains several resources for negotiating the nature and meaning of these practices. One specific device that structures documentary practices in the HTA-process is the PICO-format (Population, Intervention, Control, Outcome), a tool widely used in EBM to negotiate and formulate literature search strategies. Other structuring devices include guidelines for making a selection and for rating the quality of evidence. Ouranalysis illustrates how hospital librarians enact and negotiate documentary practices located between the instructions provided by the authoritative SBU Handbook and the material outcome of the documentary practices: the HTA-report. In this way, the institutional structures of these documents are highlighted and point to both past and future activities (cf. Østerlund, Snyder, Sawyer, Sharma, & Willis, 2015), providing a deeper understanding of how EBM is enacted in healthcare as documentary practices of hospital librarians in HTA are unfolded.

Place, publisher, year, edition, pages
Document Academy , 2021. Vol. 8, no 2, p. 1-22, article id 12
Keywords [en]
documentary practices, hospital librarians, evidence-based medicine, health technology assessment
National Category
Information Studies
Research subject
Humanities, Library and Information Science
Identifiers
URN: urn:nbn:se:lnu:diva-108680DOI: 10.35492/docam/8/2/12Scopus ID: 2-s2.0-85121362255OAI: oai:DiVA.org:lnu-108680DiVA, id: diva2:1621224
Conference
The 2021 Annual Meeting of the Document Academy
Available from: 2021-12-17 Created: 2021-12-17 Last updated: 2022-06-13Bibliographically approved

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Ahlryd, SaraHanell, Fredrik

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