Personal knowledge: a clinical perspective from the value and evince projects in health library and information services
| DOI | https://doi.org/10.1108/EUM0000000007176 |
| Date | 01 October 1998 |
| Published date | 01 October 1998 |
| Pages | 420-442 |
| Author | Christine Urquhart |
| Subject Matter | Information & knowledge management,Library & information science |
PERSONAL KNOWLEDGE: A CLINICAL PERSPECTIVE FROM THE
VALUE AND EVINCE PROJECTS IN HEALTH LIBRARY AND
INFORMATION SERVICES
CHRISTINE URQUHART
cju@aber.ac.uk
Department of Information and Library Studies, University of Wales
Aberystwyth, Llanbadarn Campus, Aberystwyth SY23 3AS
The progress of initiatives concerned with implementing evaluated
clinical research (such as evidence based medicine and clinical effec-
tiveness) is dependent on the way individual health professionals
actually acquire, use and value clinical knowledge in routine prac-
tice. The findings of two research projects, the Value and EVINCE
projects, are compared with studies of the consolidation and appli-
cation of clinical knowledge in clinical decision making. The Value
project was concerned with the ways in which information from
NHS libraries might be used in present and future clinical decision
making. EVINCE was a similar impact study for nursing profes-
sionals. Both studies confirmed the importance of personal clinical
knowledge. Health information services need to use a variety of
strategies and knowledge management skills to ensure that the eval-
uated research evidence is assimilated and implemented into practice.
1. INTRODUCTION
There seem to be varying interpretations of the term ‘knowledge management’
and this section introduces some concepts and definitions which are relevant to
the ways health information professionals might support and develop the ‘knowl-
edge base’ of health care. The term knowledge management often seems to be
associated with hopes for a more sophisticated use of information systems and
technology to serve decision making in organisations, though the knowledge of
the business and acquired expertise of staff may be more important to the organi-
sation than the documentation and databases it has about its products and cus-
tomers. Databases by definition handle data, presumably providing information to
those running the organisation. Decisions are made on the basis of knowledge
which may require synthesis of many items of information over a period of time.
Using the value added framework of Taylor [1] this can be viewed as the
increased value provided to data as it is processed through data, to information, to
informative knowledge, productive knowledge and from there, through decision
processes to action. Taylor distinguishes between the stages of informative
knowledge and productive knowledge, and probably the processes involved in
bridging those stages of the knowledge generation process are of most interest to
those promoting the skills of information professionals in ‘knowledge manage-
ment’. Of particular concern in health information are methods for filtering the
420
Journal of Documentation, Vol. 54, No. 4, September 1998
© Aslib, The Association for Information Management.
All rights reserved. Except as otherwise permitted under the Copyright, Designs and Patents Act
1988, no part of this publication may be reproduced, stored in a retrieval system, or transmitted in
any form or by any means, electronic, mechanical, photocopying or otherwise without the prior
written permission of the publisher.
Aslib, The Association for Information Management
Staple Hall, Stone House Court, London EC3A 7PB
Tel: +44 (0) 171 903 0000, Fax: +44 (0) 171 903 0011
Email: pubs@aslib.co.uk, WWW: http://www.aslib.co.uk/aslib
Journal of Documentation, vol. 54, no. 4, September 1998, pp. 420–442
vast amount of biomedical literature in the databases, so that users might quickly
retrieve, preferably at the point of care, the information they may need to guide a
clinical decision.
There is in knowledge management a greater emphasis on working within and
for the organisation (rather than acting as a source of information on external
sources) in order to capitalise on internal skills and know-how, and that requires
excellent communication and information presentation skills [2]. For those infor-
mation professionals working within the NHS there is a distinction between the
‘information manager’ who is usually responsible for the patient record type of
data and management information, and the librarian who is responsible for text-
based sources and therefore more concerned with external sources of information
and databases such as MEDLINE. Gaining an organisation-wide perspective is
possibly very difficult in the NHS as departmental boundaries militate against the
type of collaboration desirable.
Buckland [3] distinguishes between information as ‘information as process’ as
the act of telling and being informed, and ‘information as knowledge’ as what is
perceived in ‘information as process’. One view of the key characteristic of
‘information as knowledge’ is that it is intangible, but that it can be expressed and
communicated by ‘information as thing’ which are representations of knowledge.
In the wider sense the latter might viewed as Popper’s World 3. World 1 is the
world of material things, World 2 represents our thinking, feeling, believing and
knowing and World 3 the results of interaction between Worlds 1 and 2. Just how
Popper’s ideas about World 3 relate to information science activities and the con-
structs placed on ‘knowledge’ and the growth of knowledge has been a matter of
debate [4, 5, 6], but the differences between informative and productive knowl-
edge, and Popper’s Worlds 2 and 3, may underlie many of the problems of decid-
ing on the meaning of relevance in information retrieval. Relevance statements
are arguably dynamic rather than static and depend on the mental state and con-
text being considered at that particular time by a user [7]. The interaction between
the item retrieved and the user’s cognitive state must be considered to understand
the nature of relevance to the information seeker. Health information profession-
als need to be aware of the context of information need and use by the clinician or
manager to provide information relevant to the decision process. Whether work-
ing as a librarian or as an ‘information manager’ understanding that context can
be very difficult in a large organisation such as the NHS, sometimes justifiably
described as a collection of tribes rather than a unified organisation.
For designers of information systems and the information professionals work-
ing with those systems there is always a need to consider the informal sources of
information as well as the formal, published sources, and the channels of com-
munication used for those sources. Software for group working may formalise
and replace, to some extent, existing informal communication channels but it
could also build on and reinforce the informal communication channels. For dis-
semination and implementation of research findings the means of commu-
nication and the processes involved in the stages from informative through
productive knowledge to action are of particular interest to those funding
research which has an immediate application to the health and welfare of the
population. As knowledge managers health information professionals may need
September 1998 CLINICAL KNOWLEDGE
421
Journal of Documentation, Vol. 54, No. 4, September 1998
© Aslib, The Association for Information Management.
All rights reserved. Except as otherwise permitted under the Copyright, Designs and Patents Act
1988, no part of this publication may be reproduced, stored in a retrieval system, or transmitted in
any form or by any means, electronic, mechanical, photocopying or otherwise without the prior
written permission of the publisher.
Aslib, The Association for Information Management
Staple Hall, Stone House Court, London EC3A 7PB
Tel: +44 (0) 171 903 0000, Fax: +44 (0) 171 903 0011
Email: pubs@aslib.co.uk, WWW: http://www.aslib.co.uk/aslib
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