My blog post for this week is sitting over there on the NAHSL blog. I hope you’ll click on the link below and visit. My thanks, again, to NAHSL for offering financial support to help me attend the annual meeting of the Medical Library Association this year.
[Alternate Title: The Sheep that Wags the Wolf’s Tail]
A few years back, I made a deal with a friend to run the Chicago Marathon. I’d run several marathons previously, but none in a number of years. I was nowhere near the shape I wanted to be in when I made the deal and as both my friend and I were trying to be healthy, it was a win-win situation. At least it seemed that way. I trained in the winter, indoors on the treadmill. Once spring came, I moved outside. Week after week, I slogged through, never feeling like I was gaining any stamina, losing any weight, or getting any healthier. As summer came along and I started to stretch out my miles, I found myself getting pretty sick after running. I couldn’t eat anything without having serious digestive troubles. It got to the point that after running I’d stick with a smoothie and not much else. Even that didn’t always go well. I’d never had this experience in past training and kept chalking it up to being out of shape.
Then, one Friday evening I went for a 12 mile run – struggling through it as my gut rebelled against me. I finally finished, stopped by the 7-11 for a Gatorade, and drove home. After showering, I had a smoothie and settled in to watch the Red Sox. Next thing I knew, I was on the floor of my bathroom and next after that in an ambulance to the emergency room. I’d never been in an ambulance before – and that’s about the only positive I can think of regarding the experience.
After a night in the ER, tests that revealed nothing much, trips to my doc and a couple of specialists, the vascular surgeon told me that he suspected I had celiac artery compression syndrome (or median arcuate ligament syndrome). He also said, as I described my symptoms related to running with him, that he’d never heard of it being associated with exercise.
Being the medical librarian that I am, I set about searching PubMed (now that I knew some terms to search) to learn about what was going on inside of me. Mostly, I was looking for something that would link my training with this syndrome. Lo and behold, I found one. One. That was it. One case study about one individual – an elite runner who’d suffered something similar to what I was experiencing. Granted, I was hardly “elite” in my running, but the symptoms and situations described for this runner were just what kept happening to me.
I promptly sent a copy of the article to my surgeon and then, a couple of weeks later when I was wheeled into the operating room for an arteriogram to confirm his diagnosis, he said to everyone in the room, “If you have any questions, ask Sally. She’s read more about this than you have.” (Though fortunately not more than my surgeon!)
This is a long, round-about story to demonstrate a point – when it comes to evidence, a case study that resonates with you, the individual, is worth as much as any randomized control trial.
Evidence-based practice is THE term in medicine today. As noted by Stewart Donaldson, Christina Christie, and Melvin Mark in the introduction to their book, “What Counts as Credible Evidence in Applied Research and Evaluation Practice?” we live in an evidence-based society. Evidence-based medicine, evidence-based mental health, evidence-based management, evidence-based decision making, evidence-based education, evidence-based coaching, evidence-based policy, evidence-based sex education, evidence-based fill-in-any-blank are just some of the examples they list from a quick Google search of “evidence-based practice”. For those of us who have taught any course related to evidence-based practice, we know all about the EBM Pyramid and the hierarchy of quality when it comes to evidence. At the top of the pyramid sits the randomized control trial and systematic reviews. Further down, the anecdotal case study. In other words, something happening to one or two people – like me and that other runner – simply doesn’t qualify as enough evidence to state that there is any connection between exercise and celiac artery compression syndrome.
Except when it is enough. As it is/was for the two of us (and no doubt a few others).
I found myself thinking often of my personal case history and the evidence-based pyramid during a number of sessions that I attended during last week’s annual meeting of the Medical Library Association. Why? Well, mostly because I attended a lot of talks on the new roles that librarians and other professionals working within libraries, i.e. PhDs in bioinformatics, are assuming today. People are doing an awful lot of interesting things related to specialized services. I count myself in that lot. I may well be an evaluator now, but I personally think it’s simply an extension of the specialized work that I was doing in the library. But the thing that I kept noticing – and a point I raised in one of the sessions – was when, if ever, will we get past case studies related to these services? When, if ever, will we be able to say as a profession that the successful new roles and services that some libraries are offering today are roles and services that can be adopted broadly? When, if ever, will we have enough evidence that demonstrates the success is based more on the service and the role, and less upon the individual delivering it?
Watching Twitter throughout the meeting, I noticed one person tweet a picture of a slide from Bart Ragon’s (University of Virginia) presentation, “Where is My Data Scientist?” (Disclaimer: I was in a different session at the time, thus am taking Bart’s slide out of context.) The slide read, “Unless you are Kristi Holmes or Michele Tennant – Most librarians lack any of these skills.” For those less familiar with MLA, for many years, Kristi (formerly at Washington University, St. Louis, now the Library Director of Galter Health Science Library, Northwestern University) and Michele (University of Florida) were known as the two PhD biochemistry people in our midst. They were anomalies; scientists working in medical libraries. Today we have more – Jackie Wirz at Oregon Health Sciences University, Meng Li and Yibu Chen at the University of Southern California, and Tobin Magle at the University of Colorado Denver to name a few – but they still remain oddities.
When I asked the panel of Kristi, Tobin, Jackie, Meng, and Jerry Perry (former director of UC-Denver’s medical library, soon to be the same at the University of Arizona’s health sciences library) this question about case studies versus a broader body of evidence, Jackie admitted that sometimes she does wonder if people call on her because they think “Jackie can help” or if they think the bigger, “the library can help.” I don’t mean to suggest that the two are mutually exclusive, but how much are our trends towards specialized services redefining the health sciences/medical library profession, as a whole, and how much are they simply taking advantage of particular individuals and the strengths, expertise, etc. they bring to a particular library?
One of the bits of advice that Kristi Holmes offered during this session was, “Build the best library for your institution, thus what works here may not work there.” It’s hard to argue that this isn’t good advice, yet at the same time I can’t help but wonder about how well it sums up our future as a profession. It’s becoming more and more specialized, more and more individualized, and the parts aren’t easily interchangeable anymore. This can be either good or bad for us. Thinking to what Mae Jemison said in her McGovern Lecture (I wrote about this for the NAHSL blog and will share the link when it’s published), innovation is not inherently good or bad; progressive or regressive. It’s the choices that we make around our innovations, our new ideas, our new roles, and our new services that ultimately make the difference.
I’m a librarian with the title of “Evaluator” sitting in an office in the UMass Center for Clinical and Translational Science. Jackie Wirz is a PhD biochemist and molecular biologist with the title “Biomedical Research Specialist” and an office in the OHSU library. What do we have in common? What do we do that can be teased out, taught to others, and adopted by other libraries, centers, or institutions? To me, that’s a BIG question and something worth continuing to try and answer/address as our profession continues to redefine itself for the future (and now).
Earlier today, a very nice first year medical student came by my office and apologetically asked me if I could tell her where the offices of our Institutional Review Board people are. I don’t work in the library anymore, you might recall, and now my office sits in a maze of other offices on the 7th (top) floor of the ambulatory care center of our medical complex and medical school. It’s not a place that anyone wanders past. Mine is not an office that someone might simply pop in for a visit. It’s out of the way. And as I said to my former colleagues in the Library and my friends on Facebook, I admittedly miss such interruptions. Not all of the time, mind you, but one of the greatest joys that I knew as a librarian was simply answering someone’s question and / or helping them in some way that made their day better. The student was SO grateful when I got up and walked her around the corner to the IRB folks. She thanked me several times. It was a flashback to those days of yore … oh, 3 months ago or so.
For ten years, I spent the better part of my working days answering people’s questions. Either answering them directly, looking for the answer for them, or helping them learn how to find the answer for themselves. All day long, the overwhelming majority of sentences spoken to me ended in question marks. Librarians answer questions.
Evaluators, on the other hand, ask them. This is what I’m quickly learning. We are the ones who need the answers, thus we’re the ones who ask the questions. How well did “X” intervention work? How much time was saved by implementing “Y” into the process? What does “Z” do for you that no other letter of the alphabet ever did for you before?
But I’ve also learned that there’s a speed bump; the researchers and clinicians and other users of the resources and services that I’m evaluating … well … they typically aren’t librarians. In other words, I don’t think that they like answering questions as much as any librarian does.
“It’s a simple survey,” I claim.
“It won’t take more than 5 minutes of your time.”
“The results will help us help YOU!”
“I’d be ever so grateful,” said Babe the Pig. (If you miss the reference, check out the movie.)
And still, getting people to answer questions is way harder than I ever imagined. I’m actually very good at talking to people, and usually pretty good at getting people to talk to me. It was one of the skills and characteristics that I honed as a librarian / informationist that I figured would be easily transferable to my new role. Not so much. At least not yet.
It could be the method – the dreaded survey. People don’t like them. Heck, I don’t like them. But in some cases it is the most appropriate and most efficient method for getting the data (answers) you need for the evaluation. I read and studied and asked about writing good questions. I worked with seasoned researchers to put my survey together. I piloted it with different groups and made all of the necessary tweaks based on the feedback I received. I picked my target audience carefully. And once I felt confident about the whole thing, I let it loose.
And then … I waited.
And sent out a couple of reminders.
And broadened my audience.
And worked some different angles to reach people.
And waited some more.
I’m still waiting; waiting for the responses to grow to some level that will afford me some information needed to present my findings to a couple of different groups. It’s coming along, but golly it’s slow. And such a cumbersome process. Ask me a question and I’ll happily answer for you, straightaway. But waiting for others to answer me … well, the tables have turned, my friends.
A number of years ago, the librarians at Lamar Soutter Library, UMass Medical School, received the directive, “Get Out!” Our Library Director wanted us out of our cubicles and away from our desks. She wanted us to go to the people that we served. If people didn’t need to come to the Library anymore, the Library needed to go to them. And thus was born our embedded librarian program.
One of the very first lessons that I learned when I started getting out of the Library was that I needed to learn about politics. I remember going to my Library Director and asking if she could give us a lesson on the topic during one of our professional development meetings. Fortunately, she understood where I was coming from and from that point on, was open and willing to answering any questions any of us had regarding who was who and how things worked, politically, at the Medical School.
Our political system has become so broken the past few decades, it’s easy to think of politics as a dirty word. We think of corruption and conniving and backstabbing and the like. But the truth of the matter is that most, if not all, organizations and institutions exist in some sort of political atmosphere. If we’re lucky, it’s NOT a destructive framework, but it is an existing structure all the same.
When I was earning my library science degree from Syracuse, I had to take a course on management and one of the required textbooks was Lee Bolman and Terrence Deal’s book, Reframing Organizations: Artistry, Choice, and Leadership. The “Political Frame” is one of four organizational frameworks that they present and they describe it as follows:
The political frame views organizations as alive and screaming political arenas that host a complex web of individual and group interests. Five propositions summarize the perspective:
- Organizations are coalitions of various individuals and interest groups.
- There are enduring differences among coalition members in values, beliefs, information, interests, and perceptions of reality.
- Most important decisions involve the allocation of scarce resources – who gets what.
- Scarce resources and enduring differences give conflict a central role in organizational dynamics and make power the most important resource.
- Goals and decisions emerge from bargaining, negotiation, and jockeying for position among different stakeholders.
(Bolman & Deal, Reframing Organizations, 2nd ed., p. 163)
Now that I work in a different environment than the Library, I’m learning a different political landscape. Different people, different personalities, different programs, different priorities. I’m still in the same institution, so I have a slight head start, in that I at least know the people; by name and position, if nothing else. I also know, thanks to my years in the Library, that walking into situations without respecting the politics is not only naive, but can be downright disastrous to any efforts you’re attempting. It’s a really important lesson and a skill set that’s not necessarily taught in graduate school or in continuing education classes. That’s a shame, because when we pretend that politics doesn’t matter or that it’s a dirty game that we want to avoid, we’re setting ourselves up for trouble. Politics is an eight letter word. There’s no need to not talk about it.
Worcester, Massachusetts got slammed by a blizzard this week, bringing out the hearty nature in all of us New Englanders. What’s a little (34″) snow to dampen our spirits? I made a big pot of chili, watched a couple of movies, read a little, and hung out with my pets while the snow flew. Then yesterday, I joined everyone else in the neighborhood in the first great dig out of the winter. It’s what you do when you live here. No complaining needed. Born out of the spirit of the Puritans that settled here, New Englanders have a reputation for hard work and frugality. Granted, it’s been some time since the days of the Pilgrims, and regional distinctions fade as we’ve become a much more migratory society over the centuries, but we still think of Southern hospitality, Midwestern friendliness, Western pioneers, and hearty New Englanders. And yesterday, we hearty folks were shoveling.While we praise hard work and frugality, these traits also run counter to much that Americans dream to achieve today. Retiring early, becoming a millionaire overnight, achieving fame and fortune by winning a talent contest … these are the ideas behind bestsellers and top rated television programs. We talk the talk of hard work, pulling yourself up by your bootstraps, scraping and scrapping and saving for our dreams; these are the bedrocks upon which America was built and, thus, they remain a part of our societal DNA. As one of our Founding Fathers, Benjamin Franklin, said, “The way to wealth depends on just two words, industry and frugality.” In theory. But in reality, for more reasons than we can count, they are less and less the walk of America.
Economists speak of “frugality fatigue” as a driving force behind folks living in debt. As a species, we aren’t always very good at delayed gratification. We want what we want now and we’ve built a society that feeds this human habit in so many ways. Thus, when we also hear the popular mantra “do more with less” in our workplaces and business, it’s not something that we necessarily want to hear. It becomes a very negative thing. It wears us out, after awhile. We get stretched too thin. We simply cannot do more and more with less and less. In this sense, frugality becomes our enemy.
But is it? Was Mr. Franklin wrong? Or is there a way to look at “do more with less” that prompts something beyond stress?
According to Navi Radjou, an innovation strategist in Silicon Valley, the answer to that question is yes. In his thought-provoking TED Talk, Creative Problem-Solving in the Face of Extreme Limits, he outlines his theory of frugal innovation. In this brief talk, he gives lots of examples of people living in conditions where resources are often extremely limited, yet rather than limiting their ability to solve problems, the situation actually enhances their creativity and results in solutions that they would likely never come up with in a land of plenty.
They can magically transform adversity into opportunity, and turn something of less value into something of high value. In other words, they mastered the art of doing more with less, which is the essence of frugal innovation.
~ Navi Radjou
We hardly need to live in abject poverty to take advantage of this idea. Librarianship, and any profession struggling with finding its footing and value in tough times, can tap into the one resource that’s common in most every situation, human ingenuity. Radjou calls it our most abundant resource. We need to find ways and create situations that foster our ingenuity. Maybe, the pressure cooker of a “do more and more with less and less” work setting can be the impetus for this. Maybe not knowing what’s coming next, not knowing where we belong, not knowing how to define and/or redefine ourselves is just the environment we need to push us towards creative solutions.
In many ways, I’m glad that I’ve entered my new role as an evaluator without a lot of traditional knowledge and background in the subject. Yes, I’ve been reading and studying up on the basics, but lacking the resource of years of experience and know-how, I find that I’m able to come up with some different thoughts and ideas and solutions that I probably wouldn’t have come up with otherwise. It’s like the team that enters the big game for the first time. They don’t know enough to know to lose.
One of the great things about evaluating the impact of clinical and translational research is that nobody really knows exactly how to do it yet. This is what I tell myself. It helps me put aside any anxiety of knowing that I don’t necessarily know what I’m doing, and sets me free to try all sorts of things in doing my job. It’s my way of making the most out of my limited resources and thus practicing frugal innovation. And that can be downright exciting.
A couple of weeks ago, Francis Collins, Director of the National Institutes of Health, issued a gracious and thoughtful statement on the announcement of Donald Lindberg’s retirement as Director of the National Library of Medicine. Dr. Lindberg has held this post for more than 30 years and as any and everyone knows, the past 30 years in libraries and/or information science has seen monumental change. Dr. Collins lauded Dr. Lindberg’s leadership throughout this time. He also said this:
Trained as a pathologist, Don re-invented himself as an expert and groundbreaking innovator in the world of information technology, artificial intelligence, computer-aided medical diagnosis, and electronic health records.
Doctors seem to do this all of the time or at least they seem to be able to be many things at one time. We celebrate doctors who are also writers, doctors who are also artists, and doctors who are excellent teachers. We think little of showcasing their ability to be multi-talented. In this statement, Dr. Collins praises Dr. Lindberg for being able to be something else besides a doctor, or better put, to be an expert in medicine AND an expert in informatics.
I share this because I was recently speaking with a doctor about how I was an expert in library science and something else. More specifically, I was explaining how my expertise in library and information science lent itself to being an expert in something else. And when I said this, the doctor looked at me somewhat quizzically. “Really?” she asked, the implication being, “I can’t even imagine.”
I was hardly resentful about the encounter because to tell you the truth, it happens all of the time. While we don’t bat an eye at the fact that doctors can be multi-talented, the challenge is always there for us to convince them that they’re really not the only ones on whom this characteristic falls. And that’s part of our job. There’s no use grousing about it or getting all bent out of shape. Instead, we need to simply get out there and demonstrate that librarians can be experts in lots of things, too. Sometimes, we can even re-invent ourselves as experts in completely different areas without forsaking our expertise in librarianship.
As we celebrate the many skills and talents of our patrons, let’s celebrate them in ourselves, too.
I subscribe to a couple of TED Talks feeds and thanks to that, I found a link in my email this morning to a talk by Kare Anderson, a columnist for Forbes who writes about how and why people make connections with one another. I took the 10 minutes required to watch the talk and couldn’t have been happier that I did. Not only was it inspiring on a personal level, but also because it was inspiring on a professional level. As Anderson shared a story about how she connected several people that she knew over a shared interest in public art, I couldn’t help but think and see how she’d make a great librarian (if she wasn’t a great journalist already). Bringing people together, connecting them, is what we need to do in our profession today, perhaps more than ever. As I’ve written before, the library long served as a physical place where different people gathered and found connections. If/when you’re working with a patron group who rarely if ever come to the library anymore, they’ve lost that opportunity to connect. We, the librarians who go out and meet them where they are, we bring that connectivity of the library to them. That’s a big part of our job. And as Anderson says, that work is the work of OPPORTUNITY MAKERS.
Near the end of the talk, Anderson lists the traits of opportunity makers:
So here’s what I’m calling for you to do. Remember the three traits of opportunity-makers. Opportunity-makers keep honing their top strength and they become pattern seekers. They get involved in different worlds than their worlds so they’re trusted and they can see those patterns, and they communicate to connect around sweet spots of shared interest.
Can you see where and how librarians fit this mold? I sure can!