NHS Education for Scotland

NHS Education for Scotland Editorial Welcome to the summer 2005 issue of Chrysalis, which focuses on outreach and sharing knowledge across boundaries...
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NHS Education for Scotland

Editorial Welcome to the summer 2005 issue of Chrysalis, which focuses on outreach and sharing knowledge across boundaries. These constitute the core themes of From Knowing to Doing, the implementation framework which is now beginning to shape the work of the Knowledge Services Group as a whole, and the future design of the e-Library in particular. Many thanks to all of you who fed back comments during the consultation phase. Your input has provided valuable insights into how we can best support widespread involvement in implementation throughout the service. Outreach and cross-boundary working are, of course, the basic aims of Managed Knowledge Networks (MKNs), which play a central role in From Knowing to Doing. The MKN model was launched at the recent conference Working together to Bridge the Knowing-Doing Gap on 4th May in Dunblane. An overview of this event summarises how MKNs can be understood in terms of the Communities of Practice concept of individuals and organisations taking responsibility for managing and sharing knowledge. Jim Turner describes “a day in his life” as Knowledge Networks Coordinator, while Annette Thain outlines how her role as the newly appointed Cancer Knowledge Services Adviser aims to guide development of MKNs and their supporting Portals as systems for engaging healthcare communities in managing knowledge in specialist contexts. Lynn Caldwell, Laura McCaig, and Andy Hyde highlight key features of the new Portals which will support knowledge access and knowledge sharing for MKNs in Stroke, Diabetes and Healthcare Associated Infections.

Derek Boyle, Zena Mulligan and Peter Stirling, from Sandra Davies’ team, provide details of their new training and outreach programme to support librarians in use of eLibrary subscription resources. This group training will shortly be complemented by a Virtual Training Area within the e-Library offering regular online training sessions. Finally, turning to cross-sectoral outreach and partnership working, results are presented of a recent survey of health information skills training needs within a cross-section of public librarians. All these developments create new contexts for applying the familiar librarian skills of supporting user information needs in the healthcare setting. A window of opportunity now exists to build on these skills to create a central role for librarians in facilitating the sharing of knowledge within and across organisations. Dr Ann Wales [email protected]

Contents Managed Knowledge Networks Working Together to Bridge the Knowing-Doing Gap ………………………2 Cancer Knowledge Services Adviser…..4 Supporting the Diabetes MKN……………4 Supporting the Stroke MKN………………5 Supporting the HAI MKN…………………..6 e-Library Training and Outreach…………7 Health Information Needs of Public Librarians …………………………………….9 A Day in the Life of: James Turner, Knowledge Networks Coordinator ……..10 Who We Are…………………………………11

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Managed Knowledge Networks: Working Together to Bridge the Knowing-Doing Gap Report of an NHS Education conference Dunblane Hilton, 4th May 2005 “Knowledge is power, but the NHS will remain the weaker if that knowledge is retained in isolated pockets across the service and not shared to the benefit of all.” The inspiration behind this event was the self-evident fact that sharing knowledge to improve practice is central to improving patient care. The strategy for NHS Scotland Knowledge Services has recognised from the first that knowledge needs to be shared across boundaries of discipline, organisation and sector in order to support all stages of the patient journey. This conference presented the Managed Knowledge Networks (MKN) model as a way of encouraging healthcare staff involved in similar challenges to access and share knowledge to support patient care in their working contexts. The day was opened by Ann Markham, the Chair of NES, and Chief Executive Malcolm Wright, who emphasised that managing the challenges currently facing the health service depends largely on developing innovative ways of translating knowledge into practice.

Etienne Wenger presenting on Communities of Practice

Etienne Wenger, the first keynote speaker, is an international consultant in learning systems and originator of the communities of practice concept which underpins the MKNs. This model can help us to understand how healthcare staff interact with the knowledge base and to support that process.

Communities of practice are groups of practitioners who share similar work interests and who interact regularly to learn from and with each other. Healthcare teams and networks already operate in this way to a considerable extent, but fostering these communities calls for investment of energy in understanding knowledge needs and in building a knowledge-sharing culture. Etienne described the transition from technologyfocused knowledge management in the early 1990s to the current recognition that knowledge “lives” in communities and that connecting people is key to translating knowledge into practice. He offered several examples of successful communities in healthcare, and highlighted that the patientprofessional negotiation can evolve into a community relationship which generates a new type of knowledge.

Professor Chris Ham

Etienne’s presentation was followed by Professor Chris Ham, well-known as one of the UK’s leading health policy analysts. Professor Ham spoke from the organisational perspective on sharing knowledge to contribute to service improvement and redesign. He outlined lessons learned from work carried out by the NHS Modernisation Agency in England and from a partnership between NHS England and the US healthcare provider Kaiser Permanente. A key message was the fact that change cannot be directed from the top but requires engagement by practitioners within the organisation – very much in accordance with the MKN model. Three key roles were identified in developing successful organisational knowledge networks– “mavens” (knowledge experts); “connectors” (networkers) and “sales people” (persuaders). The final keynote speaker was Dr Anna Gregor, Lead Cancer Clinician for Scotland,

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who has played a leading role in development of Managed Clinical Networks for cancer. Dr Gregor argued that networks, supported by knowledge and information, have to be the way forward for cancer care. Cancer MCNs illustrate how network members can work together to share and transform their individual knowledge base into new knowledge that can be applied to working practice. This is illustrated, for example, in the protocols and pathways produced and adopted by each MCN. More work remains to be done in enabling this sharing of knowledge between hospital and primary care sectors so that consistent standards of care are provided throughout the whole patient experience.

This series of presentations concluded with demonstrations of new e-Library technology tools now available to support MKN s including Knowledge Exchanges; crosssearching of remote information services; and three new Portals for Stroke, Diabetes and Healthcare Associated Infections. Finally, a workshop session gave delegates the opportunity to address core themes in relation to development of MKN s. Each workshop group identified a long list of benefits for staff, healthcare organisations, and ultimately for patients. It was recognised that achieving these benefits will involve persuasion and motivation of healthcare staff, engagement of clinical and organisational leaders, and confronting the challenge of inequitable access to information. “Building connections” and “working together on shared issues” were welcomed as key messages from the day.

Angela Hissett demonstrating the Mental Health Portal

Presentations from the Knowledge Services Group highlighted aspects of the new implementation framework set out in From Knowing to Doing, based on teams and partnerships increasingly taking responsibility for managing knowledge to support the patient journey. Annette Thain, former MKN Project Manager, and now Cancer Knowledge Services Adviser, described how MKN s link people and organisations in sharing information and knowledge. Six MKN s exist at present – for cancer, coronary heart disease, diabetes, healthcare associated infections, mental health, and stroke. It is essential that MKN s are owned and managed by healthcare staff themselves. For this reason, each MKN is supported by a management team drawn from the wider community - comprising a Steering Group, Editor and Editorial Team. These management teams will oversee outreach and community development within the MKN and will guide future development of the eLibrary portals providing knowledge resources and services relevant to the needs of the network.

Workgroup discussing development of the HAI MKN

This conference marks an important beginning, placing MKN s, and knowledge management more generally, firmly on the map of NHS Scotland. While the terminology may as yet be unfamiliar, the emphasis on knowledge access and knowledge sharing has struck a chord of recognition within the service, generating opportunities for Library Services as a whole to profile their role in bridging the gap between knowing and doing.

A

packed

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Cancer Knowledge Services Adviser: A new Knowledge Management role Annette Thain [email protected] I have recently been appointed to this new post of Cancer Knowledge Services Adviser, after two years as project manager for the Managed Knowledge Network for Cancer, CHD, and Mental Health in the West of Scotland. This new role will enable me to build on work initiated by this project but on a national basis. It will include both, further development of the Cancer Knowledge Portal and the community aspect, via the Cancer Managed Knowledge Network (MKN).

This is a great opportunity to work with the subject specialists to encourage their better understanding of the role of the libraries and the librarian in contributing to better management of their knowledge. If I had to sum up the role in one sentence I think it would be ‘to investigate opportunities to link Cancer Knowledge Portal closer to the working practices of the subject specialists’. Last but far from least I very much hope you, the NHS librarians, will work with me to make this a reality.

With the extra support of this post the Cancer MKN will lead the developments of subject specific MKNs. The Cancer MKN network development plan, to be agreed over the next few months with the MKN Cancer steering group, will outline intentions for needs analysis, outreach, community development including Knowledge Exchanges, developing resources and services on the portal and a staged evaluation process. Quick wins will be identified and scheduled to highlight a variety of potential development areas. Together with the Cancer MKN Editor (Lorraine McLeod) I will ensure the cancer portal content, both resources and services, are appropriate and meeting the needs of all staff working in the field of cancer care. By investigating more about how people use cancer information I will look at additional services and approaches to presenting the information in order to make access easier for all user groups. To contribute to the development of the portal the steering group and I will identify partners, both internal and external to the NHS, and develop these partnerships for example to provide direct cross searching of their material from the e-Library and vice versa. I will work to promote knowledge management principles and models with cancer MCNs and communities. I will aim to keep up to date with relevant developments in the field of knowledge management and communities of practice.

Supporting the Diabetes MKN Laura McCaig, Information Manager [email protected] The new Diabetes Managed Knowledge Network portal was launched on 4th May at Dunblane Hydro as part of the conference Managed Knowledge Networks: Working Together to Bridge the Knowing-Doing Gap. Approximately 150,000 people in Scotland have been diagnosed with diabetes, while many more are undiagnosed. The chronic nature of the disease, and the predicted 'epidemic' of diabetes, as a consequence of changes in lifestyle and diet, is putting increasing strains on healthcare systems and societies, and therefore poses significant challenges for NHS Scotland. It was for these reasons that Diabetes was chosen as a suitable topic for one of the new portals. After extensive user consultation, the new portal was been designed to portray a more user-friendly, clean and clear interface, while still recognisable as part of the NHS Scotland e-Library. The colours were chosen to mirror similar UK Diabetes websites such as Diabetes UK and Diabetes in Scotland. As well as the usual high quality content and functionality associated with the e-Library, the Diabetes portal has some unique features: Hot topics - a topical short-term discussion area, monitored by a member of the Diabetes Healthcare Community

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Diabetes Competency Framework - this e-Learning tool allows all staff working in the field of diabetes, the opportunity to develop a personal development portfolio. Here, they can record details of how they aim to meet their goals, as well as print a copy of their portfolio for discussion with their line managers. Patient Information - access to informative, reliable sources of diabetes specific information Local Information - As well as national information, the portal also concentrates on providing relevant local diabetesspecific information such as local Managed Clinical Networks websites and handbooks. Drug Information - access to diabetes specific areas of the BNF and DrugDex Guidelines - NHS QIS criteria and SIGN guideline recommendations have also been added Simple and easy to use, healthcare staff, researchers and patients can all benefit from this great one-stop shop for diabetes information. For further details, please contact the Diabetes MKN Editor: Sally Anderson ([email protected])

Diabetes Portal Homepage

Supporting the Stroke MKN Lynn Caldwell, Information Manager [email protected] The Managed Knowledge Network and portal for Stroke were launched on 4th May at Dunblane Hydro as part of the "Managed Knowledge Networks: Working Together to Bridge the Knowing-Doing Gap" Conference. The portal provides comprehensive coverage of local and Scottish stroke information together with access to appropriate UK and international information. It includes a wide range of evaluated knowledge resources including journals, books and databases; health policies and strategies; national standards and guidelines; individual NHS QIS criteria and SIGN guideline recommendations; high quality patient information; and access to the full text of the systematic reviews and journal articles referred to in the NHS QIS criteria. The portal also provides links to best evidence in stroke rehabilitation from Effectivestrokecare.org. Features of the stroke portal include: Browsing content by patient journey stage providing access to individual QIS criteria and SIGN guideline recommendations This patient journey has been taken from the NHS QIS standard: ‘Stroke Services - care of the patient in the acute setting’. The document has been broken up into the individual criteria, the associated documents and articles have been added, and then each has been allocated to a stage of the patient journey indicated by the standard. This allows users to browse information related to that stage. The same is true for the stroke SIGN guidelines. Each of these has been divided up into the individual recommendations A-D and the Good Practice Points and, like the QIS criteria, each is linked directly to the page within the SIGN guideline. Details of stroke education courses and conferences Each record contains some basic information about each event, conference or training course and links are provided to conference or course websites where available.

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Cross search facility The search functionality for the portal is provided by a new cross-search system. As well as searching the e-Library, it also crosssearches the Cochrane Library (systematic reviews, trials register and DARE), Scottish Executive Health Department, Resource Discovery Network and Health Scotland databases. The results from each search target are displayed in individual tabs and the default view is the results obtained from the e-Library. Results from other targets can be viewed by clicking on the appropriate tab. Recent journal articles This service is provided via a Z39.50 link to ZETOC, the electronic table of journal contents service from the British Library. Choosing a link on this page takes you directly to the contents page of the current issue. Should you wish to read any of the articles, a link is provided to the full text journal where available.

professionals who are concerned day-to-day with reducing the spread of healthcare associated infections. It combines the journals, e-books and databases of the NHS Education for Scotland e-library with new information collections focusing on areas such as education, policy, conferences and events. One of the key issues for staff involved directly with the fight against the spread of HAI is the need to keep up with the many stories in the press and a growing literature. The portal is using tailored RSS feeds to attempt to bring users the latest press and literature updates from sources such as Health Protection Scotland, the Scottish Health on the Web media monitoring service and various journals that are beginning to experiment with the technology. This provides a relevant and lively news section which is relatively 'automatic' and brings in stories that are grabbing national headlines. However, the value of the portal can be enhanced with local stories too – the new initiative being piloted or a research study that has been recently funded. How do HAI-relevant communities get to hear about these? The portal has a feature known as the Soapbox which allows users to post their news and announcements. It is hoped that the combination of international, national and local news will provide a unique update on the latest stories surrounding HAI, some of which relating to resources available through the e-library.

Cross-search facility in the Stroke Portal

Supporting the HAI MKN Andy Hyde, Editor, HAI Managed Knowledge Network [email protected] For those studying and working in the control and prevention of Healthcare Associated Infections (HAI), current awareness is important in an area that has regular media coverage, is served by a growing and diverse literature, and is the theme of many events and initiatives at a local, national and international level. The newly launched HAI portal is a collection of resources and services aimed at health

HAI Portal homepage, keeping users up to date

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e-Library Training and Outreach

Training

Derek Boyle, Zena Mulligan and Peter Stirling [email protected] [email protected] [email protected]

Between August 2005 and July 2006 we will be organising training in all our database resources. Service providers have agreed to offer varying amounts of training and a timetable of events to cover this twelvemonth period is currently being prepared. Sessions for both library and health care staff will be delivered at a range of venues around the country.

Are you familiar with all the subscription resources available to you in the e-Library? Do you know how to get the best results from these resources? You now have the opportunity to improve your awareness of electronic resources as the e-Library embarks on a three-year programme of training and outreach. During this period training will be provided and promotional materials delivered on all the major subscription resources available from the e-Library. This programme will be aimed primarily at health sector librarians, and in some cases at specific categories of NHS staff, clinical and non-clinical, throughout Scotland. In last month’s issue of Chrysalis, an article on e-Library content highlighted the Knowledge Services Group’s role in working with suppliers and librarians in planning online information skills training “to ensure that we realise the full potential of these new resources, uniquely available to NHS Scotland.” Promotion Starting in August, the first year of the programme will focus on providing libraries with promotional materials for all of the eLibrary’s subscription databases. These will cover new resources such as MIDIRS and Clinical Evidence and established services such as OVID and Ebsco-Host. The Knowledge Services Group is currently in consultation with service providers on gathering promotional items such as posters, pens, user guides and other training materials to provide to NHS Scotland libraries via printed and electronic format. Where possible, items will be customised to include the e-Library logo, to give materials a familiarity that will appeal to e-Library users.

We have organised training for OVID and the new version of the Cochrane Library for August 2005 and for the BMJ and Clinical Evidence in September. Further training on all other resources will be delivered throughout the year and there will be also be virtual training sessions offered on a number of services. With over fifteen providers offering training our goal is to cover one or two resources each month. The training programme as it currently stands is shown overleaf. Virtual training The virtual sessions will provide real-time training from your work or home computer from the following providers: CSA, MIDIRS, OVID, Proquest and Science Direct. The e-Library will have a dedicated site where you can register and take training on these resources – we will again provide more details in the next few weeks. Get involved In a recent survey on the impact of the eLibrary the most common reason for non-use stemmed from a need for training. The training and outreach programme aims to address this by empowering you to make best use of the resources available to you from the e-Library. The coming three years offer you a great opportunity to get the most out of the e-Library so keep an eye on developments and get involved.

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e-Library Resources: Training Programme August 2005- March 2006 Resource

Date

Venue

Notes

OVID

1 August 2 August 4 August

Edinburgh Glasgow Aberdeen

3 hour sessions Focus on new OVID interface

Cochrane Library

9 August 10 August 11 August

Dundee Edinburgh Glasgow

2 hour sessions

BMJ/Clinical Evidence

7 September 8 September

Dundee Glasgow

Venue to be confirmed

MIDIRS /Internurse

26 September 27 September 28 September

Edinburgh Aberdeen Glasgow

Half-day for each resource Open to users and librarians Half-day session. Open to users and librarians

MD Consult

18 October 19 October

Aberdeen Edinburgh

2 hour sessions Cover advanced searching

RECAL

2 November 3 November 4 November

Edinburgh Aberdeen Glasgow

Open to users and librarians

NetLibrary

? November ? November

Aberdeen Glasgow

Dates to be confirmed

ZETOC

5 December 6 December

Aberdeen Glasgow

EMERALD

23 January 24 January 25 January

Edinburgh Aberdeen Glasgow

2 sessions on each day; one for librarians, one for managers.

ASSIA CSA/ASSIA/Refworks

21 February 23 February

Glasgow Aberdeen

Focused on users Focused on librarians

EBSCO-Host Proquest Science Direct Web of Science

To be determined To be determined To be determined To be determined

Internurse

We hope that this information will help you to plan your diary for the coming months. Booking forms with full details of timing , venue and course content, will be circulated 4-6 weeks prior to each course.

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Health Information Needs of Public Librarians Report of a survey conducted by Cathy Zahra, formerly Training and Outreach Officer with the Knowledge Services Group. Results were analysed by Lynn Allan, Information Support Officer. This survey, conducted during JanuaryFebruary 2005, aimed to define requirements for health information skills training among public librarians. Questionnaires were distributed to public libraries via key contacts in North Lanarkshire, East Ayrshire, and Aberdeen City Council. Within each library, the member of staff responsible for answering the highest number of reference enquiries was asked to complete the questionnaire. 52 questionnaires were distributed, and 33 returned - a response rate of 63%. Services varied widely with regard to the frequency of health-related questions, ranging from 1% to 40% of total reference enquiries. In one special case, 99% of enquiries were health-related. One respondent said that they received no healthrelated enquiries, and 4 respondents left this section blank. Based on the total (healthrelated and non-health-related) recorded weekly reference enquiries, it can be inferred that these public librarians receive at least one health-related enquiry every month, and in some cases up to 10 enquiries per week. The most common type of enquiry is about specific diseases or conditions (90.6% of respondents), followed by questions about alternative therapies (71.9%). Questions are also frequently asked about drugs/medications and healthy living (62.5% and 65.6% respectively). In order to answer these enquiries, public librarians will usually consult reference books (87.5% of respondents) or the Internet (78.1%) . Only 9.4% of respondents used journals, either print or electronic, and only 3.1% turned to helplines such as NHS 24. Two respondents reported that they would sometimes consult their local NHS library for help.

With regard to specific Internet sources, Google is overwhelmingly the first port of call (87.5% of respondents). Currently, 25% might use NHS Direct Online; 21% the Health Scotland website, and 12.5% the NHS Scotland e-Library. Public librarians encounter a range of difficulties in attempting to answer healthrelated enquiries. Incorrect spelling of diseases or medications (68.8% of respondents) and difficulty in defining user need (59.4%) are the problems most commonly reported. Concerns were also expressed about understanding medical terminology (43.8%) and ensuring information quality (34.4%). Selecting from a range of potential health information topics, public librarians were clear that they were most interested in receiving training on quality websites (62.5%), with small group training being the most popular format (37.5%). 48.5% of respondents were interested in receiving training in use of eLibrary, and in fact three of these librarians had already done so. Overall, this survey provides valuable pointers regarding the present and potential future role of the public librarian in health information provision. While the extent of public librarian involvement in this field is currently variable, there is a significant, interest in learning more about high quality online health information resources such as the NHS Scotland e-Library. As recognition grows of the role of information in empowering patients and carers to participate in shared decision-making, NHS librarians in some areas are already networking with their public library colleagues to offer training and support. Hopefully, over the coming months, both sectors will be able to explore the potential for closer collaboration across the NHS/public library interface, sharing resources and expertise to improve access to good quality health information.

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A Day in the Life of…

library or specific portal. They will also send out events that the users may find interesting.

James Turner Knowledge Networks Coordinator [email protected]

Before I go to lunch I have to get the meeting minutes from the editors meeting pulled together and ensure that everyone knows what they have to do as a result of that meeting. I also have to advise the editors of the next steps for this week so that everyone is working to the same goal.

Before I start telling you all about my typical day I should explain what my role is all about and the challenges I face. The role is about helping NHSScotland staff to develop managed knowledge networks across the NHS and ensuring that the supporting applications enable this development. Obviously before I can help people develop these MKNs I have to let them know about them, so myself and the rest of the knowledge networks team will embark on a large scale outreach programme this will include a number of workshops and training sessions. This will give as many people as possible the opportunity to see and discuss the MKN approach with the team. So there is a very quick overview of my job and so here is a quick overview of my day here at NHS Education Scotland. The day starts with a long look in the mirror, and an even longer battle with the hair – for those that have already met me I apologise for the state of it. Then a trip on the train to Glasgow and the day starts … Over the past few days I have been out of the office meeting with people to explain the approach or going to conferences and asking them to get in touch. As a result I have loads of email to get thorough to either setup meetings or send out.

Lunchtime!! Great an opportunity to catch up on the gossip and to discuss the some heavy weight issues such as what is happening in that top-notch BBC drama Cutting it! Then in the afternoon I attend the Special Health boards Librarians meeting and give the MKN Generic presentation. Which as usual goes down well. There were loads of questions and by the end of the session I was starting to tire of my own voice – and that is a very rare event. Then back to the office to pull together the stats for each of the portals to see what effect all of this out reach is having. Then I have another meeting to attend this time it is to go through our requirements for the various aspects of the e-library to ensure that we improve on our ability to meet our user needs. Then that’s it another day has come to an end, run along to the station and go home. Should you have any questions regarding, my role please don’t hesitate to contact me on the number below. Remember if you would be willing to spend 15 minutes reviewing a website in your area of expertise or would like to suggest your favourite website – please email me at [email protected] . I will be pleased to hear from you.

As part of my role I have to coordinate the activities of each of the editors for each of the 6 portals. To help them understand what is happening I write an email to them once a week to make sure that they are up-to-date with everything that is happening at the Knowledge Services Group, so I tell everyone about the outreach that has been carried out and if this has resulted in any next steps for them. Part of the editorial role is to review websites for new resources in their field of interest and pass this to me to catalogue, which is basically adding these resources to the eNHS Education for Scotland, Knowledge Services Group Chrysalis Issue 8

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Senior Systems Developer Vinh Tran [email protected]

Knowledge Services Group NHS Scotland Library Service Development Coordinator - Dr Ann Wales [email protected] Tel: 0141 223 1551 Administrator – Eileen Jeffcoatt [email protected] Tel: 0141 223 1550 e-Library Information Management Team e-Library Team Leader - Sandra Davies [email protected] 0141 223 1554 Information Manager - Zena Mulligan [email protected] Information Manager - Derek Boyle [email protected] 0141 223 1552 Information Officer – Peter Stirling [email protected] 0141 223 1435 Information Support Officer- Lynn Allan [email protected] 0141 223 1558 Senior Information Manager (responsible for Unified Library Management System initiative) Appointment to be announced shortly

e-Library Systems Team Lead Systems Developer Faiyaz Shaik [email protected] 0141 223 1556

Consultant Developer Scott Tunstall [email protected]

Librarian Staff Development Staff Development Manager, NHS Scotland Knowledge Services Appointment to be announced shortly Training and Outreach Appointment to be made

Knowledge Networks Cancer Knowledge Services Annette Thain [email protected] 0141 223 1553

Adviser

-

Knowledge Networks CoordinatorJames Turner [email protected] 0141 223 1559 Information Manager – Lynn Caldwell [email protected] 0141 223 1431 (From 4th August) Information Manager – Laura McCaig [email protected] 0141 223 1557 Information Specialist, Remote and Rural Care Appointment to be announced shortly. North of Scotland Infrastructure Project

NHS

Knowledge

Project Manager – Nicky Jarman [email protected] 01224 554694

Senior Systems Developer Ramana Geyyer [email protected]

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