The Health Equality Library Portal (HELP)

This is the fifth in an ongoing series of posts explaining the approach which our team at NHS North West has taken to driving up equality outcomes in one NHS region... and the spinoffs of national best practice which that work has generated.

Making research easy

Today I'm writing about our creation of this public resource: http://www.help.northwest.nhs.uk

In the last few posts I've concentrated on the theory and strategy for equality outcomes improvement. In part four I explained how all this needs to be grounded in evidence.

In previous posts I've been talking about the need for research and evidence to inform an overarching strategy. However, the same obviously then applies when commissioners and providers are analysing the effects of policy decisions in the way they organise services and staff them.

Our Landscape of the Region research at NHS North West found that organisations were typically weak in finding and using the appropriate kinds of evidence to inform their decision making. To quote the report:

Without accurate and up-to-date data, any Equality Impact Assessment or Action Plan is questionable. Not only must actions be based on appropriate research findings and/or numerical evidence but that same data is also necessary in order to provide a baseline for subsequent measurement of results. (2.5.8)

Regionally and nationally all the indications point to the fact that even where data is unquestionably available for some of the ETGs, many organisations, particularly PCTs, are nationally failing to demonstrate the use of disaggregated data in order to drive strategic planning. Therefore plans are vague, rather than focussed, and provide no measures for outcomes. [..] Trusts were asked what data sources they use to inform operational and strategic planning, and whether they use other sources such as the Census, national / regional market analysis reports or Local Authority data. (3.6)

Following this we did some more specific survey work on the kinds of external information sources which organisations were using and (just as importantly) which ones they were missing. We did this across a wide range of managers and organisation types besides Equality and Diversity practitioners and leads.

What we discovered confirmed what we already suspected. Most people used only a relatively small set of sources for information in this area. They tended towards 'official' sources, such as Medical Journals, the Census, Local Authority statistics or the Public Health Observatories.

However, many of these sources they relied on were themselves poor in covering needs and experiences related to diversity. Managers were particularly unaware of so-called 'grey research' -- the kind of studies which only get published by advocacy and support charities, filling gaps that are not being addressed by mainstream peer-reviewed journals.

Improving access to evidence

All our research pointed towards one conclusion. There was a desperate need for an authoritative and easy to use resource that E&D teams and managers could refer to as a one-stop-shop to find the kind of information which they hitherto regarded as hard to access. Something that pulled it all together.

We found a need to satisfy two primary requirements:

• A well catalogued library of published documents - either pointing to where the publishers' web sites or (where not available elsewhere) holding the documents itself
• A similarly indexed portal to help managers find entire web sites for organisations where they could make contacts or find more information directly.

Whilst we were at it, we saw that this service could also sensibly include:

• An up to date calendar of diversity-related events -- a listing to remind people of community specific dates when it would not be a good idea to organise meetings, and also to signpost interesting courses, meetings, etc..
• An editorialised news feed, where we could raise the profile of anything relevant (later supplemented by a blog too)

Cataloguing is Key

As I personally come from a consulting background in document management and retrieval, I was keen that the new service should pay particular attention to what we call the information 'taxonomy'. A taxonomy is a system for classifying things.

Online libraries succeed or fail on the simple test of whether they help you find what you want.

Google is successful as a general search tool because most users are able to find just what they want on the first page of results. However, it is poor at finding the kinds of information we are talking about here, without a lot of extraneous material as well.

None of the existing software we looked at could categorise information in the way that Equality and Diversity research is naturally classified.

In the end we came up with a bespoke scheme which simultaneously satisfied two overlapping requirements

• A formal hierarchic classification system representing the major diversity categories (gender, race, disability, etc...) and the unique ways in which each of those are then broken down. The sub-categories for race and ethnicity are completely different from those for disability, for instance
• An open ended system for describing what kind of subject matter the document or web site is concerned with. This saves having to rely on guessing which words a document might contain if it was talking about a particular topic.

It's also vital that everyone uploading information into the system should catalogue the same document in a consistent way. This is always a tricky problem, since different people will see a document and the cataloguing options in different ways. The key, however, is to strike a balance between providing enough terms to distinguish subjects sensibly, but not so many as to encourage ambiguities.

Introducing HELP

The name 'HELP' was my idea. We needed something snappy that summed up what we were trying to achieve. The name also says exactly what the service provides. It is both a library (a place cataloguing and storing documents) and a portal (a system pointing you to web based information which we don't ourselves control).

Getting the custom software developed was only a small part of having something ready for people to use. The bigger challenge was to stock the system with authoritative information from day one.

We knew that if we launched the service and people couldn't find what they wanted on their very first visit then they would be unlikely to return.

In the end we launched HELP in the late summer of 2009 with around 1,400 documents fully catalogued, and with the portal section listing almost 300 web sites.

Stocking the system with all this information was a massive undertaking -- helped immensely by the Service Level Agreements we have with a set of third sector organisations who are expert in each Equality Target Group.

The task we set for each stakeholder organisation was to supply us with all the resources which they thought NHS managers should be able to find in order to research the needs of their communities. This had the advantage that they automatically provided only the most up to date and most relevant resources.

Maintaining HELP

A resource like HELP cannot stay still. Its' usefulness and reputation is only ever as good as the last successful search.

To build HELP we brought in our stakeholders to do the research and some temporary staff to do the inputting and checking.

But the knowledge base and the world wide web are both constantly changing.

On a simple level, if you point a catalogue entry at someone else's web site then you have to keep periodically checking that it hasn't moved. This has proven to be a task that's a bit like painting the Forth Railway Bridge. The moment you've completed it, you have to start again from the beginning.

New documents are always being published too, and some others cease to be so relevant or are superceded. For this we've built a requirement into our SLAs with our third sector equality stakeholder partners to keep us supplied with new content.

Open to all

We never wanted HELP to be a closed resource. One of our earliest design decisions was that it should be accessible to everyone -- not just the NHS managers in our own region, whose needs were the original driver, but other public, private and third sector staff, who are basically all needing the same kind of information.

What HELP strives to achieve is to ensure all those people only need ONE place to go and look.