Executive summary from summary report. Scope of evaluation Clinical librarian services have developed in different ways in different organisations. The common theme to any clinical librarian role is provision of information services at the point of need, often at, or near the point of care. The clinical librarian works with health professionals in their work settings, outside the library. In the North Wales project, the roles included: • Literature searching skills training (NW Wales) • Support for multidisciplinary teams (including journal clubs) (NE Wales, Conwy & Denbighshire. The Clinical Librarian started in post on 15 September 2003. The evaluation plans were prepared immediately after that, but the formal work could not start until March 2004, when ethics approval was obtained. The Clinical Librarian post formally completed in February 2005. The aim of the evaluation was to provide evidence to inform future structures of health library support for clinical governance. The evidence was obtained by showing how the clinical librarian service impacted on clinical practice, and the information seeking and critical appraisal skills of staff. In addition, the impact of the service on the health library activities was studied. From this evaluation, some lessons may be drawn for future development of Welsh health library services. Objectives The objectives were to: • Assess which aspects of the clinical librarian services were used • Estimate time (and money saved) through clinical librarian searches, compared with searching conducted by clinical staff • Estimate the effect of information skills training on staff searching patterns, and time taken to search • Examine the benefits to clinical practice (in terms of clinical governance activities and policies) • Examine whether information skills training has affected skills and confidence • Explain some of the factors affecting the working of the clinical multidisciplinary teams with the clinical librarian, and whether attitudes towards the clinical librarian changed. Key messages Clinical librarian support, through training or team working: • Increases the willingness of staff to search for information to support clinical decisions (thus decreasing risks to patient care of unsafe decisions) • improves staff skills in searching for the best evidence, among all staff groups, with the greatest effect (at this stage) among doctors (enhancing critical appraisal skills) • changes team attitudes and cultures towards searching for the evidence – a more discriminating approach emerging as the norm. Information found by the clinical librarian is also shared among the team (saving time and benefiting team learning) • reaches staff who are not currently library users (with benefits for clinical governance) • makes searching for the evidence more efficient and effective (health professionals believe that searches by the clinical librarian are more comprehensive than theirs) Recommendations for clinical librarian services The clinical librarian service should be targeted to areas where support is appropriate and likely to be cost-effective. These include: • Journal clubs • Support of newly established multidisciplinary community teams. Recommendations for future health library services The future library service model might have a library services manager responsible for services across a Trust or several small Trusts. In this shared services model, there would be opportunities for specialist librarians to work as outreach trainers, clinical librarians, or research support. Supporting this structure there would be a group of support staff, who themselves might have to specialise in tasks such as cataloguing, dealing with customer enquiries (face to face and remote enquiries). The support staff, after all, are the ‘front face’ of the library service to many of the users. The support staff generally work in the physical library space. The librarian may not be, as the role will require liaison work outside the library.