Show me the money. Return on Investment in NHS Libraries. Andrew Brown, Library Services Development Lead, Frimley Health NHS Foundation Trust

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1 Show me the money Return on Investment in NHS Libraries Andrew Brown, Library Services Development Lead, Frimley Health NHS Foundation Trust

2

3 Background ROI Study Day for NHS South Central Library Staff Development Group (2011) Measuring the return on NHS Library Services as assets Sandra Ward & Ian Wooler

4 Background ALIA (Australian Library & Information Association) report Worth Every Cent and More (2013) Australian health libraries return an average of $9 for every $1 invested

5 Background Knowledge for Healthcare (2015) HEE s 5-year development framework for NHS Libraries in England we will commission a study of return on investment in healthcare library and knowledge services for the NHS in England. (p.45)

6 Background MSc Econ Library & Information Studies ( ) Dissertation module 2015 Choice of topic: ROI

7 What is Return on Investment? How much you get back for what you put into something (Lown & Davis, 2009) A figure that tells how high the return is on each dollar invested (Aabø, 2009)

8 What is Return on Investment? ROI = Gain from investment Cost of investment x 100% Cost of investment Sometimes expressed as Cost Benefit Ratio (CBR) = Gain from investment Cost of investment

9 What is Return on Investment? Key challenge for non-profit, public sector organisations: How to calculate Gain from Investment? Strategies used by libraries include: Time saved Cost avoidance Contingent valuation

10 What is Return on Investment? Why ROI? Economic pressures Growing need for accountability Need to demonstrate value in alignment with organisational objectives Questions about the role of the library in relation to new technologies Being good at what you do and at the services you provide is no longer good enough Hendricks & Wooler (2006)

11 What is Return on Investment? Concerns about ROI May result in narrow bottom line view of libraries ROI methodologies lack of consistency The insanity of ROI (Neal, 2011) inappropriate, unsophisticated and exploitable The question of CREDIBILITY

12 What is Return on Investment? But ROI can still be an important technique for communicating library value, if it is: Calculated using consistent & credible methods Aligned to organisational strategic objectives Used as part of a suite of tools for demonstrating impact and value

13 Library ROI Studies 2009 meta-analysis of library ROI studies by Aabø: 38 studies included, from 1995 to 2008 Majority from US Over 30 studies from the public library sector Mean ROI/CBR = 1:4.9

14 Library ROI Studies Public Libraries: Main method: Cost avoidance e.g. savings for users through not having to pay for similar goods/services elsewhere Key studies: Florida Public Libraries (2004): taxpayer ROI = $6.54 for every $1 invested South Carolina Libraries (2005): CBR=1:4.48 Other ROI public library studies also conducted in South Korea, Australia and Norway

15 Library ROI Studies Public Libraries (UK): Bolton public libraries (2005) used both contingent valuation and consumer surplus methods CBR = 1:1.6 Arts Council England (2014) contingent valuation Average willingness-to-pay for library services via additional council tax= per year ( for non-users)

16 Library ROI Studies Academic Libraries: Key study: University of Illinois, Urbana- Champaign (UIUC) (2007) Used grant income generated through the use of library materials to calculate ROI $4.38 generated for every $1 invested in 2006 UIUC model adopted & adapted by other academic libraries (e.g. Humboldt University, Berlin; University of Colorado)

17 Library ROI Studies

18 Library ROI Studies Health Libraries: Early ROI study Dept of Veteran Affairs hospital libraries (2009): used clinician time saved (i.e. savings derived from salaries) and cost avoidance. CBR=1:4.1, and ROI ranging from 201% to 450% University of Maryland Health Sciences & Human Services Libraries (2012): used online ROI calculator to estimate time saved for each book borrowed CBR= (ROI of 2,234%) Atlanta paediatric hospital used pay-per-view costs to derive CBR of 1:2.76 for its journal collection

19 Library ROI Studies Health Libraries: Australian Health Libraries an independent ROI assessment of 300 libraries Report Worth Every Cent and More (2013) Finding - $9 for every $1 invested Used time saved & cost avoidance methods, with some attempt at providing credible estimates e.g. assumes users take 3.3 times longer than library staff on literature searching, but also provides a more conservative CBR (1:2.7) which assumes users and library staff take the same time.

20 Library ROI Studies Other Library Sectors: Corporate Libraries Tend to use time saved (e.g. Ryan, 2006) Special Libraries (legal, technical etc.) Sometimes included in a single calculation e.g. Australian special libraries national ROI of $5.43 for every $1 invested (ALIA, 2014) School Libraries Little research into ROI main focus on impact in relation to student learning

21 Library ROI Studies National Libraries: 2003 British Library Study Widely considered a benchmark study Multiple methods, including detailed use of Contingent Valuation Looked at the total economic value to users, nonusers and the economy as a whole CBR calculated as 1:4.4; i.e generated for the UK economy for every 1 of public funding (Pung et al, 2004)

22 Contingent Valuation (CV) What is CV? An economic methodology which estimates the value a person places on a good or service A stated preference technique (as opposed to revealed preference, e.g. using market information, travel costs etc.) Asks how much an individual is prepared to pay for a good/service in the context of a hypothetical but plausible situation Elicits their willingness-to-pay (WTP) for the good or service

23 Contingent Valuation (CV) Originated in early 1960s by Robert K Davis to estimate the benefits of outdoor recreation in Maine Gained credibility and influence following the 1992 NOAA panel (National Oceanic & Atmospheric Administration) Assessed the credibility of CV Reviewed its application in the context of determining the impact of oil spills Provided recommendations for future applications

24 Contingent Valuation (CV) Since then, thousands of CV studies have been conducted in over 130 countries (Carson, 2012) Applied in diverse areas such as: Environmental Transportation Health Economics Libraries Included in HM Treasury s Green Book of guidance on the appraisal of public spending

25 Contingent Valuation (CV) Library CV Studies:

26 Contingent Valuation (CV) Benefits of CV Results in stated and direct values, rather than inferred values (such as those produced by time saved or cost avoidance methods) Tends to produce lower, more conservative and therefore more credible valuations Has wide acceptance and application in the public sector, with a substantial research base

27 Contingent Valuation (CV) Drawbacks of CV Can be expensive to implement, especially for evaluating whole services Can be complex and difficult to ensure credible standards are maintained Can be compromised by a range of methodological biases, e.g. Hypothetical bias Anchoring bias Strategic bias Information bias Free-riding, protest bidding, yea-saying etc.

28 Dissertation Using contingent valuation to evaluate the return on investment of a health library s out-of-hours access service Rationale: No previous CV studies in NHS libraries Focus on one service area, rather than the whole service, due to time/resource constraints

29 Dissertation Primary objective: To develop and implement a CV survey which will elicit library user s willingness-to-pay (WTP) for out-of-hours access to the library Secondary objectives: To use the aggregated WTP value as part of a costbenefit analysis and ROI calculation To evaluate the validity of the CV method in the context of NHS libraries

30 Dissertation Background Out-of-hours 24/7 access available to all registered library members. 10 deposit required for access card (loan period up to 1 year, can be renewed indefinitely). Third year of implementation.

31 Methodology Mixed methods: Qualitative stakeholder interviews about the value of the library in the context of organisational aims & objectives Quantitative CV survey to capture library users WTP for out-of-hours access

32 Methodology Stakeholder Interviews Short interviews, 6 questions on ROI, CV, other types of value, and the importance of demonstrating value to the Trust Pilot survey, followed by snowball sampling

33 Methodology CV Survey Probability sampling to improve data validity and generalise sample WTP mean to population WTP mean Entire pop n of library users with out-ofhours access cards (N=305) Sample size for Confidence Level 95% and CI 10 (n=73) 73 access cards randomly selected from list of cards on loan Online survey created (SNAP) and piloted

34 Methodology Survey Design Hypothetical situation

35 Methodology Elicitation Method Payment Card Generally regarded as a useful visual aid to the valuation process, less prone to anchoring bias

36 Methodology NB. other elicitation methods are available: Open-ended Referendum Vote for or against a particular value Bidding Game initial referendum vote, followed by higher amounts until respondent gives a no response Double-Bounded Dichotomous Choice (DBDC) initial referendum vote followed by one more amount (either higher or lower depending on initial response)

37 Methodology Potential Biases Hypothetical Bias Potentially off the cuff /meaningless responses; can be avoided by giving Don t know or No options Anchoring or Starting Bias Respondents may become fixated on the first amount seen as a signal of what the WTP should be. Usual strategy to avoid this is to randomise the starting bid Strategic Bias Attempts to influence the outcome of the survey by providing skewed values Information Bias Lack of information may bias responses Range Bias e.g. payment card range implying min/max values

38 Methodology Protest Voting characterised by zero WTP amounts; the respondent doesn t trust the purpose of the survey Free-riding respondents assume someone else will pay for or fund the service in question Yea-saying respondents give a Yes response or a higher bid than their true WTP amount

39 Methodology Dissonance Minimising A strategy to reduce protest bidding & yea-saying, allowing respondents to express support for the service without committing to a payment

40 Methodology Cheap Talk A strategy to minimise overestimation of WTP, controlling for hypothetical bias, information bias, and yea-saying

41 Methodology Certainty Question A final question to control for additional bias. Only very certain responses are included in the WTP estimation

42 Methodology Other Questions Job Category stratifying criterion, indicating level of proportional representation in responses Three traditional usage and evaluation questions for service cost calculations (e.g. cost of using PCs) and other qualitative/quantitative feedback Independent variables which may be expected to correlate with WTP amounts (for use in regression analysis):

43 Results Stakeholder Interviews Three interviewees from senior management IM&T, Postgraduate Education, and Lead for the Clinical Learning Environment Limitation no response to invitation from Finance dept. Qualitative Analysis themes: Economic Necessity of demonstrating value, good value for money. Practical Difficulties of demonstrating economic value National Targets the importance of demonstrating support for national targets, in alignment with Trust objectives Risk Avoidance what is the risk of not having access to up-to-date information? Patient Safety identified as a key area where library value might be demonstrated

44 Results CV Surveys Response Rate:

45 Results Job Categories:

46 Results Access Card Usage: 80% - Very satisfied with out-of-hours access 15% - Satisfied

47 Results WTP Amounts: 19 respondents were very certain of their stated WTP amounts All other responses were counted as 0 (established practice for CV studies)

48 Results WTP Sample Mean: Non-parametric sample Skewed distribution Mean WTP = 5.64 Bootstrapping technique used to calculate the 95% confidence interval: Original sample resampled 100,000 times 95% CI between and 7.989

49 Results Regression Analysis: Investigates the relationships between variables Calculates the line of best fit Used in CV surveys to test the validity of WTP responses by looking at their relationship to other theoretically relevant variables (e.g. income, proximity to site)

50 Results Coefficients magnitude of association between WTP and the independent variable Positive relationships with Distance, Pay Band and Affected ( To what extent would you be affected by the loss of the service? ) t Stat statistical significance P-value (needs to be less than 0.05 to reject nullhypothesis of no correlation with 95% confidence level)

51 Results Data validity therefore could not be established, since none of the coefficients were statistically significant at the required p<0.05 Possibly due to high number of zero WTP amounts and low response rate

52 Results Aggregating WTP for the Pop n : Low response rate non-probabilistic data Use analytical weights to improve representativeness of sample (Pearce & Ozdemiroglu, 2002) job category Analytical weight = Pop n % Sample % Weighted WTP = Total WTP x Analytical weight Weighted sample mean WTP = 7.50 Aggregate WTP = 2,287.50* * i.e. estimated total income for 1 year based on WTP values for out-of-hours access the Gain from Investment

53 Calculating ROI Aggregated WTP amount (3-year period): 3 x 2, = 6, Service Costs (3-year period): Implementation costs of access system Variable costs e.g. staff time & consumables (PC/printer power, paper & toner) Broken down into: System costs ( 6,715.20) Admin costs (- 1,097.84) Consumable costs ( ) Total costs = 6,551.36

54 Calculating ROI Cost Benefit Ratio = 1:1.0475

55 Summary Aims & Objectives Aim and Primary Objectives Calculate ROI using a CV survey to elicit users WTP Secondary Objectives Aggregated WTP value to calculate ROI and CBR Evaluate the validity of the CV method in the context of NHS libraries

56 Summary CV Method Pros Established method for evaluating public sector goods/services Based on stated preference rather than inferred values (e.g. time saved, cost avoidance) Tends to be more conservative & credible Cons Complex process to ensure validity Susceptible to a range of biases Statistical analysis may require expert advice Potentially expensive & time consuming to implement

57 Conclusion CV important tool that should be considered in future studies ROI has a role in the overall evaluation framework for NHS libraries, but there are other types of impact (e.g. patient safety, national targets, strategic objectives) which continue to be important The challenge for NHS libraries to keep demonstrating value & impact across this range of areas, while also proving value for money to stakeholders and funding bodies

58 Conclusion Suggestions for Future CV Research Non-users (option value) Other elicitation methods Other services / whole services Improving response rates Advanced regression analysis

59 Any questions?

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